Patient Registration

Your privacy is important to us and the information that you provide below will be kept confidential and only used in accordance with the regulations set out in the Commonwealth Privacy Act 2010. Your contact details will only be used as required in the provision of the healthcare service that you have been referred for. Your contact details will not be used for marketing purposes and cannot be provided to any third parties without your prior consent.

Title *

First name *

Last name *

Date of Birth *

Phone *

Email Address

Street address *

Suburb *

Postcode *

State *

Do you have a Medicare?

(No)

Are you pregnant?

(No)

Is the patient a child?

(No)

Referring Doctor

Name *

Street address *

Suburb *

Postcode *

State *

Is your general practitioner different to the referring doctor?

(No)

Miscellaneous

Do you have a referral form?

(No)

One of the ways we maintain high standards is through teaching, education and research and you may have a trainee doctor, midwife or sonographer involved in your care. If you would prefer not to have a trainee involved in your care or if you have any other questions please indicate this in the comments section below.

By completing this form you give permission to Women's Imaging Group to access any records that may be relevant to the healthcare service that you have been referred for (such as prior scan reports or hospital discharge summaries). I also give consent to send relevant information to relevant medical third parties.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

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Mon - Fri: 8:00am - 5:00pm

Sat - Sun: Closed

Public Holidays: Closed

T: 02 4228 9711
F: 02 4228 9118
E: [email protected]

10/363 Crown Street
Wollongong NSW 2500

For your convenience we have allocated patient parking spaces at the rear of our building on 363 Crown Street.

Our practice is one block away from Wollongong train station and we are immediately located next to stops for the following bus routes:

Premier bus company routes 1, 2, 3, 4, 6, 7, 8, 10, 11, 24, 31, 33, 34, 35, 36, 37, 39 and 57.

DIONS bus routes 90 and 92.

Request a Form

Download the practice request form to fill up.

Download

Opening Hour

Mon - Fri: 8:00am - 5:00pm

Sat - Sun: Closed

Public Holidays: Closed

Our location

T: 02 4228 9711
F: 02 4228 9118
E: [email protected]

10/363 Crown Street
Wollongong NSW 2500

Parking

For your convenience we have allocated patient parking spaces at the rear of our building on 363 Crown Street.

Patient Registration