• Mon - Fri: 8:30am to 5:00pm
  • Saturday: 8:30am to 1:00pm
  • Sunday: Closed
  • Ph: 02 9484 1552
  • Fax: 02 9484 6201
Shop 8A, Beecroft Village Arcade
6-8 Hannah Street Beecroft, NSW 2119
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New Patient Information Form

Beecroft General Practice is committed providing quality facilities and services to doctors. Please assist your doctor by completing this form:

Contact Information
Emergency Contact
Next of Kin
Healthcare Identifiers

  • Dept of Veteran Affairs card colour

Cultural Identity

  • To assist with health initiatives, do you identify as Aboriginal and/or Torres Strait Islander?

  • As Australia is a genuinely multicultural society, and to tailor appropriate health care, encourage understanding and appreciation between people from different nationalities and cultures – do you identify as someone from a culturally and/or linguistically diverse background?

  • Do you require an interpreter service?

Your Health Information

  • Allergy Information – Do you have any allergies or are you sensitive to drugs or dressings?

  • Current Medications – Please list all of your current medications, including complementary and over the counter medicines (eg homeopathic medicines, vitamins and minerals etc)

  • Medical History – Do you have or have you had a history of the following?

Lifestyle Risk Factors

  • Are you a smoker?

  • Do you drink alcohol?

  • Do you use recreational drugs?

Family Health History Information

  • Have any members of your family been affected by any of the following medical conditions?

Immunisations

  • Please list any recent immunisations you have had:

  • If completing this form for a child, are their immunisations up to date?

Privacy collection notice

Beecroft General Practice Pty Ltd, ACN 169 461 947, as trustee for The Beecroft Unit Trust (Beecroft General Practice) is committed to supporting doctors to provide quality healthcare. In order to provide you with high quality patient care, Beecroft General Practice, your doctor, and other healthcare practitioners who may provide healthcare services to you at Beecroft General Practice from time to time, require your consent to collect, use and disclose personal information (including sensitive information) about you.

The collection of this information is reasonably necessary for the activities of Beecroft General Practice, your doctor and other healthcare practitioners who may provide healthcare services to you at Beecroft General Practice from time to time. This information is also required to provide accurate medical diagnosis, appropriate treatment, continuity of healthcare and to be proactive in your healthcare needs.

To ensure quality and continuity of patient care, your personal information (including sensitive information) may be shared by and between Beecroft General Practice and the independent healthcare practitioners who treat patients at Beecroft General Practice, and with other external healthcare providers and administrators (eg radiologists, pathologists, specialists outside of this medical practice, and public or private hospitals) from time to time. We do not anticipate that your personal information will be provided to any overseas recipients.

More detailed information about the way Beecroft General Practice and the independent healthcare providers who treat patients at the practice use and disclose your personal information (including sensitive information) is set out in our Privacy Policy, which is available on our website: www.beecroftgp.com.au.

Please address all requests or questions about how we deal with your personal information, requests for access to your information to:

Practice Manager
Beecroft General Practice
Shop 8A, Beecroft Village Arcade
6-8 Hannah Street Beecroft, NSW 2119
Phone: 02 9484 1552 | Email: reception@beecroftgp.com.au

Patient consent

I have read this privacy collection notice carefully and I consent to the collection of my personal information (including sensitive information) by Beecroft General Practice, my treating doctor and other healthcare practitioners who consult from Beecroft General Practice who may provide healthcare services to me from time to time, and the use and disclosure of that information by them in accordance with this notice and Beecroft General Practice’s Privacy Policy.

I understand that I am not obligated to provide any information requested of me, but that my failure to do so might compromise the quality of healthcare and treatment given to me.

Beecroft GP