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Please tick this box to confirm you have read and understood our Team Care Process
Please tick this box to confirm you have read and understood our Booking and Cancellation
Please tick this box to confirm you have read and understood our Fee Schedule
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Do you identify as Aboriginal/Torres Strait Islander (If so please advise)
Child's medicare details
Please provide us with a description of why your child needs to be seen at our clinic, so that we can triage your enquiry to the most appropriate member of our team:
Please upload your referral (in any)
Child’s Regular GP
Parent/Carer (1)
Parent/Carer (1) address
Parent/Carer (1) medicare details
Do you need to add a second Parent/Carer?
Parent/Carer (2) address
Parent/Carer (2) medicare details
Are there any current parental or court orders in place?
If you have ticket Yes, please provide details for our team and send any legal documents to reception@paediatricpeople.com.au