New Patient Registration Form



If you are a New Patient to Cumberland Street Clinic please bring the following to your next consultation:

1. A valid Medicare card if you have one (check expiry date)

2. If you are a Workcover patient, you will need to inform your Employer prior to the consultation and bring your employer’s contact details for verification to arrange payment through Workcover.

3. Please arrive 10 minutes before your consultation to complete a New Patient Registration Form or alternatively you can complete it online below.

4. If you need to change your appointment time please inform us as soon as possible on (02) 4990 3222.

5. We look forward to seeing you!



In Case Of Emergency
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Personal History
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Thank you for completing your Online New Patient Registration Form.
This form will be automatically emailed to us ready for your next appointment.
Please call Cumberland Street Clinic on 02 4990 3222 if you have any enquiries or wish to make / confirm an appointment.