Welcome to Malvern East Medical (ME Medical)

We look forward to helping you on your wellness journey.

Click Next to start the sign up process, read our T&Cs and book your appointment

Patient Acknowledgement - Medical Practice, Privacy Policies, Terms & Conditions

Please make sure you have read the Practice Policies, Terms & Conditions carefully and have any questions or concerns ready for discussion at your consultation. If you would like further information before booking your initial consultation, please contact us at malverneastmedical@gmail.com.

I have read the Practice Policies, Terms & Conditions and understand why collecting information about me/my child is necessary. I am also aware that this Practice has a Privacy Policy for managing patient information.

I understand that I am not obliged to provide any information requested of me/my child. I also understand that failure to provide this Practice with all the information it needs may restrict the ability to provide the quality of health care and treatment that I/my child require.

I am aware that I have the right to access the information collected except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in those circumstances.

I understand that if my information is to be used for any purpose other than that set out above my permission in writing will be sought before any action is taken.

I acknowledge that I have read the Practice Policies, Terms & Conditions and Privacy Policy before signing and that a member of staff of this Practice has at my request clarified any aspects of it that I did not at first understand. Consent is required for the release or acquisition of medical records.

I agree to the Medical Practice Policies, Terms & Conditions *

I consent to accept terms & conditions on storage and use of my personal information in accordance with the Privacy Policies *

I hereby give my permission for ME Medical to either release or request any medical information/records relevant to me as required *

Yes, subscribe me to learn more about ME Medical news, products & services

Signature *

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Date *

Click next to provide your details

Your Personal Details

Date of Birth *

Title *

First Name *

Last Name *

Gender *

Mobile Number *

Email *

Address *

Street address *

City *

State *

Postcode *

Medicare/Individual healthcare identifier (IHI)

Either your Medicare Number or IHI is required to send electronic prescriptions.

Do you have a Medicare card? *

YesNo

Medicare number *Please use Numbers only with no spaces

IRN *This is the number next to your name on the card

Medicare expiry (MM/YYYY) *

If you do not have a Medicare Card, please provide or obtain an individual healthcare identifier (IHI) here

IHI Number *

Click next to answers questions related to your condition

Your Health Condition

If other, please elaborate *

Do you have any allergies *

YesNo

If yes, please elaborate *

Are currently taking any prescribed medications? *

YesNo

If yes, please elaborate *

Are you currently taking any non-prescribed medications such as vitamins or supplements? *

YesNo

If yes, please elaborate *

Any other relevant past medical history

Any other questions or concerns or information you wish to provide

Do you have a regular GP? *

YesNo

Would you like ME Medical to provide updates about your treatment plans to your regular GP? *

YesNo

Name of GP *

Clinic Name of GP *

Address of GP *

Thanks for completing the sign up process.
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