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Burwood Brickworks Medical Centre
Burwood Brickworks Medical Centre
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  • About Us
    • Mission
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  • Services
  • Allied Health
  • Patient Resources
  • Contact Us

Patient Registration

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Patient Details

DD slash MM slash YYYY

Next of Kin

Emergency Contact

Do you identify as someone from a culturally and/or linguistic diverse background?*
To assist with health initiatives - are you Aboriginal or Torres Strait Islander?*

Health Questionnaire

Allergy to medication or food?*
Smoker Status*
Alcohol Intake*
If yes, please choose standard drinks/per*
Recreational Drugs*
Regular Medications*
If yes, Please list below any medications and their doses if known – include over the counter medications and supplements*
Current/Previous Medical Conditions*
If yes, please tick any that apply*
Family Medical History*
If yes, Please list below*
Relation to you (e.g., mother, grandfather, sibling)
Condition/s
 
Our practice undertakes research, professional development, and quality assurance/improvement activities to improve patient care. All people accessing personal health information for this purpose have signed a written confidentiality agreement.
I consent to my health record being reviewed and uploaded to My eHealth Record as a part of the quality improvement activities in this practice.*
I give permission for my personal information to be collected, used and disclosed as described in this practice policy. I understand only my relevant personal information will be provided to allow the above actions to be undertaken and I am free to withdraw, alter or restrict my consent at any time by notifying this practice in writing.*
Our practice uses a reminder system to improve the quality of your health care. The practice sends reminders by mail or telephone for procedures such as vaccinations, pap smears and other health reviews.*
I consent to being contacted with reminders by sms/phone/email*

Ingleburn Family Healthcare

Ingleburn Medical Centre medicare

Ingleburn Medical Centre flags

We acknowledge the traditional custodians of the land on which we operate and pay our respects to elder’s past, present and emerging.

Living Building Challenge

Burwood Brickworks Medical Centre operates in the worlds most sustainable shopping centre, utilizing eco-friendly materials.

Contact Info

(03) 9098-0555

(03) 8640-0496

info@bbmedicalcentre.com.au

Burwood Brickworks
T41, 70 Middleborough Road,
Burwood East VIC 3151

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Opening Hours
Monday 9:00 AM – 5:00 PM
Tuesday 9:00 AM – 5:00 PM
Wednesday 9:00 AM – 5:00 PM
Thursday 9:00 AM – 5:00 PM
Friday 9:00 AM – 5:00 PM
Saturday Temporarily closed until further notice
Sunday Closed
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