9295 1988
Suite 5/5 Nichol Street, Mundaring

Forms

New Patient Information

Upload our New Patient Health Summary document. This is to be completed prior to your first consultation with the Doctor.

Patient Health Summary Form.pdf

Prescription Request Form

Under some circumstances and at their discretion our doctors may be able to provide a repeat prescription over the front counter. This will attract a minimum fee of $20. Please note requests require 2-3 working days for preparation of scripts. If you do not wish to pay a fee please ensure you have an appointment with your doctor prior to running out of your medication. If your usual doctor is not available please note you will get a prescription with a limited duration until you see your usual GP for a follow up. Completed form must be faxed to 08 9295 1935. Please ring the surgery to confirm receipt of your request.

Prescription Request Form.doc

You may also make a prescription request online by clicking here for the myhealth1st website.

Transfer of Medical Records from Previous Practice

If you wish to transfer your medical records from your previous practice please complete the document below and fax back to us on 08 9295 1935. We do not charge for this however some practices may apply a fee, please check. This service is for new existing patients only.

Request for Medical Records.pdf