We are growing and are always keen to hear from like-minded, caring, motivated and enthusiastic GPs who are passionate about delivering quality health care.
Please call the practice or alternatively Email your CV to: Recruit@junipermedical.com.au
Juniper Avenue Medical Center
New Patient Form
We are committed to providing our patients with the best care. To do this it is essential that your health record is kept up to date and accurate.
Could you please assist us by completing the following:
Surname:
Dr
Mr
Mrs
Ms
Miss
Proff
Master
First Name:
Date of Birth:
Please Circle Male / Female / Other
Street Address, Suburb, Post Code
Home Phone:
Mobile:
Email:
Next of Kin (Name, Phone)
Emergency Contact (Name, Phone, Relationship)
Medicare Number
#Ref
Expiry:
DVA Gold
DVA White
(Please tick which)
#
Expiry:
Pension Number
#
Expiry:
Health Care Card Number
#
Expiry:
Do you identify as Aboriginal or Torres Strait Islander