Heart of CanberraDr Kashif Kalam · Cardiologist

New patients

New patient registration.

Complete this before your first appointment so the rooms have your details ready. It takes about ten minutes.

Fill it in here and send it, or download the PDF to print and bring with you. Either is fine. Please have your Medicare card, any concession card, and your medication list to hand.

Download the form (PDF)

You still need a referral from your GP or another specialist to be seen. If you do not have one yet, see Appointments and fees.

Register online

Your details, straight to the rooms.

About you

Medicare and concessions

Your doctors

Emergency contact

Your health

Have you ever had any of the following?

Consent and communication

Still needed: Full name, Date of birth, Home address, Mobile phone, Medicare card number, Your number on the card, Referring doctor, Referring doctor’s practice, Name, Phone, I have read the practice privacy policy

This sends your details securely to the practice. Anything you attach is stored privately in Australia and deleted after 90 days. Privacy statement.

What happens next

Reception checks your registration against your referral and phones you if anything is missing. On the day, please still bring your Medicare card and referral letter.

If you would rather do this by phone, call the rooms on 02 6162 2741 during 9:00 am – 4:00 pm.

This form is not for urgent problems. If you have severe or sudden chest pain, call 000.