New Patient Registration

Your Appointment

Thank you for choosing Dr Arora. Please complete this form before your first appointment so we can prepare for your visit. Fields marked * are required.

Which side?

LeftRightBothNot applicable

Appointment type

In personTelehealth (video)Telehealth (phone)

Patient Details

First name *

Middle name

Surname *

Preferred name

Date of birth (DD/MM/YYYY) *

Sex / gender *

MaleFemaleNon-binaryPrefer not to say

Do you need an interpreter?

YesNo

Preferred language

Occupation *

Sports, hobbies and activities you enjoy

Contact Details

Street address *

Suburb / town *

State *

Postcode *

Mobile number *

Other phone

Email address *

We may contact you about appointments, results and correspondence by:

SMSEmailPhonePost

Next of Kin / Emergency Contact

First name *

Surname *

Phone *

Referring Doctor & Care Team

Referring doctor *

Clinic name & suburb

Usual GP (if different)

GP clinic & suburb

Other health professionals involved in your care (e.g. physiotherapist, other specialists) and where they practise

Medicare & Concessions

Medicare card number *

Ref. no. (IRN) *The number beside your name on the card

Valid to (MM/YYYY) *

Do you hold a Pension, Health Care or Seniors Health card?

YesNo

Card type

Pensioner ConcessionHealth Care CardCommonwealth Seniors

Card number

Expiry

Do you hold a DVA (Veterans) card?

YesNo

DVA card colour

GoldWhiteOrange

DVA file number

Private Health Insurance

Do you have private hospital cover? *

YesNo

Health fund

Membership number

Does your policy cover joint replacement surgery?

YesNoNot sure

Policy holder's name

Policy holder is

MeSpouse / partnerParentOther

TAC / WorkSafe / Compensable Claims

Is this appointment related to an insurance or compensation claim? *

NoTACWorkSafe / WorkCoverOther insurer

Claim number

Date of injury

Insurer / agent

Employer (WorkSafe claims)

Case manager

Case manager phone / email

Your Health

Medical conditions (e.g. diabetes, heart or lung disease, high blood pressure, arthritis)

Have you had any previous operations? *

YesNo

Any problems with anaesthetic before?

YesNo

Previous operations (procedure and year)

Do you have any allergies or sensitivities? *

YesNo

Allergy and reaction (e.g. penicillin – rash)

Current medications and supplements (name and dose)

Do you smoke or vape? *

YesNo

How much per day?

Do you drink alcohol?

YesNo

How often / how much?

Have you, or a close family member, ever had a blood clot (DVT) or pulmonary embolism? *

YesNo

Who, when and how was it treated?

Height (cm)

Weight (kg)

About Your Problem

What is the main problem you would like help with? *

How long have you had it?

Did it start after an injury? If so, what happened?

Have you had X-rays, ultrasound, CT or MRI for this problem? *

YesNo

Which radiology provider(s)? (e.g. I-MED, Lumus, Capitol, MIA, Healthcare Imaging)

Documents

Referral letter

Browse

Upload a PDF or photo, or bring it to your appointment.

Imaging reports (X-ray, CT, MRI, ultrasound)

Browse

Upload a PDF or photo, or bring it to your appointment.

Other documents (e.g. blood tests, previous operation reports)

Browse

Upload a PDF or photo, or bring it to your appointment.

How Did You Hear About Us?

How did you find Dr Arora? *

Who recommended you? (name of GP, physio, friend etc.)

Privacy, Fees & Practice Policies

YOUR PRIVACY

We take the privacy of your health information seriously. Dr Arora's practice complies with the Privacy Act 1988 (Cth) and the Health Records Act 2001 (Vic). Your information is stored securely and is only accessed by Dr Arora and practice staff involved in your care. To look after you properly, we may need to share relevant information with your referring doctor, GP, hospitals, radiology and pathology providers, and other health professionals involved in your treatment. Providing a complete medical history helps us treat you safely and effectively. Please let us know if anything about your health changes. Our full Privacy Policy is available at www.varunarora.com.au or on request.

CONSULTATION FEES

Providing specialist care to a high standard means our fees are higher than the Medicare rebate, so there will be an out-of-pocket cost for consultations. Private health insurance does not contribute to consultations in the rooms, but it does help with the cost of surgery in hospital. The initial consultation fee is $250 and review consultations are $150. Payment is due on the day of your appointment, and we can process your Medicare rebate for you on the spot. TAC and WorkSafe / WorkCover patients also pay the consultation fee on the day; please check with your insurer or case manager whether any of the cost can be reimbursed. If surgery is recommended, our team will give you a written estimate of fees before you proceed.

CANCELLATIONS

If you are unable to attend, please let us know as early as possible so we can offer the appointment to another patient.

ELECTRONIC MEDICARE CLAIMS

By signing below you authorise this practice to lodge Medicare claims electronically on your behalf so your rebate can be paid directly to your nominated bank account.

HOW WE WILL CONTACT YOU

We use phone, SMS, email and post to arrange appointments, send reminders and share correspondence. Emails and SMS are convenient but are not always fully secure; you can change your preferences at any time by letting reception know.

I confirm the information in this form is true, complete and accurate. I have read and understand the privacy, fees, cancellation, Medicare claiming and communication information above, and I consent to it. *

Name of person signing *

Signed by *

PatientParent / guardianCarer / substitute decision maker

Signature *

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Date *

Telehealth Consultations

BULK BILLING OF ELIGIBLE TELEHEALTH (PHONE) CONSULTATIONS

Some follow-up appointments may be offered by phone or video. Where a telehealth consultation is eligible for Medicare bulk billing, Dr Arora may bulk bill it on your behalf. This means your Medicare benefit is assigned directly to the practice and you will not be charged a fee for that consultation. Telehealth that is not eligible for bulk billing will be charged in line with our usual fees, and we will let you know beforehand. A telehealth consultation is not suitable for every situation; Dr Arora may ask you to attend in person if needed.

I agree to the practice bulk billing eligible Medicare telehealth (phone) consultations on my behalf, and I assign my Medicare benefit to the practice for those services. *

YesNo

Signature *

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Date *

Heidi AI Medical Scribe

ABOUT HEIDI

Dr Arora uses Heidi, a secure AI medical scribe, to help write up clinical notes and letters from your consultation. It lets Dr Arora give you his full attention rather than typing, and helps keep your records accurate and your letters to other doctors timely. Dr Arora reviews and checks everything Heidi drafts before it is saved to your record. Your information is handled securely and in line with Australian privacy law. Using Heidi is entirely your choice – you can say no, or change your mind at any time, including during a consultation, and it will not affect your care in any way.

I consent to Heidi AI scribe being used during my consultations with Dr Arora. *

YesNo

Signature *

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Date *