Please fill out all the information below and submit to Intus before your appointment. The form will take approximately 10 minutes to complete.
IMPORTANT:
- Please take time to gather all the required information before filling this form out online. This includes your insurance information, contact information for your referring GP & your current medications.
- Your information will get sent directly through to our medical records and will not be stored anywhere else.
- Items marked * indicate mandatory fields.
- On successful completion you will see a successful submission message and receive an acknowledgment email. If you do not see this, your form has not been submitted.
- If you are experiencing issues completing your Registration Form online, please contact (03) 977 5977 and one of our support staff will be happy to assist you.