New Patient Registration
Nature of work and duration involved per day:
Have you had any of the following conditions or symptoms?
INJURIES, ACCIDENTS AND HOSPITALIZATIONS
I have read and understood the pamphlet ‘Your First Visit’ and consent to an appropriate physical examination.
If you are under 16 years of age, this consent should be signed by a parent or legal guardian.
Please do not hesitate to ask one of our members of staff for the full version if our data protection policy.