Patient Registration Form

Personal Information
Referring Doctor Details
Report Address
If you would like a copy of the report to go to another doctor, please fill in the details below:
Billing Details
Medicare Card
Concession Cards

NB : Seniors Card not applicable.

Private Health Insurance
Privacy Agreement
Cato Cardiology collects and holds personal health information about you so that we can properly assess, diagnose and treat. It is sometimes necessary to disclose information about you to other health care providers. At times it is also necessary for us to obtain information about you from other medical practitioners (or the like) in the form of previous correspondence and/or test results in relation to your health. We require your consent for this. Please ask us if you wish to discuss this further.
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.