02 9251 6555 info@drfarjo.com.au

Patient Registration Form

New patients are required to fill out and submit our patient registration form. The information provided to us remains strictly private and confidential.

All fields require information to be filled out.

I herby give permission for Dr Juman Farjo to pass on and to seek medical information from any medical practitioner, who has referred, treated or will treat me as long as the exchange of information is necessary for my medical treatment.

2 + 1 =

Privacy Note: The personal and health information that you provide, and that is communicated by you will be recorded in you electronic health record. This information is collected for the primary purpose of providing you with treatment. Your information is collected and held in accordance with NSW privacy legislation under which you have access to. You may request a copy of your health record at anytime. Your request must be made in writing and approved by Dr Juman Farjo.