New Patient Form
Before your first appointment, please download and complete this New Patient Information Form.
You can either:
- Edit the PDF and type your answers on your computer or tablet, then save and email
- Write on your tablet screen using a stylus, then save and email
- Print and complete the form on paper. Scan and email, or bring it on the day
Please email to: mboffice@parkclinic.com.au
Mark Blackney’s consulting fees from January 2022
Consultation Fees
104-Initial Consultation $270
Medicare Rebate $80.85
105-Review Consultation $120
Medicare Rebate $40.65
Injection $50
No Medicare Rebate
Pensioner Fees
104 Initial Consultation $170
Medicare Rebate $80.85
105-Review Consultation $80
Medicare Rebate $40.65
Injection $50
No Medicare Rebate
Personal Collection Statement
This personal collection statement provides information to you on how your personal information is collected and used within our practice and the circumstances in which we may share it with third parties.
The personal information that we collect such as your name, address, DOB, contact telephone numbers, next of kin, Medicare card number and health fund details are recorded and forms the basis of your computer patient file. Each patient is allocated a unique individual patient file. Your details will be updated regularly to ensure your file is kept up to date.
We receive electronic and paper results and correspondence. These documents are scanned into the patient’s file to ensure we have a fully computerised patient record.
Clinical notes are recorded during the consultation. Prescriptions, specialist and allied health referrals, pathology, X-ray & scan requests are computer generated. These can only be accessed by Mr Blackney, our nurses and administration staff.
In the event that you require surgery your personal details will be passed onto the hospital that you are booked in with, including the Anaesthetist and assistant surgeon. If you are requiring a referral for either an Xray or other specialist then some of your personal details will be passed onto the chosen practice.