Patient Registration

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Name*
Address
Indigenous Status
(Select all that apply)
Card Type

Parent / Guardian details

(If patient is under 18 years old)
Name
Address

GD Details

GP Name

Referral

Please upload your referral below.

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    AI Consent

    During your visit today, our specialists are using artificial intelligence (AI) software tool Medow to assist with documenting your consultation.

    This consent form seeks your permission to use Medow AI to capture and transcribe conversations between you and your doctor.

    • Your clinician may have Medow AI running in the background during your consultation.
    • Medow AI will listen to, and transcribe, your conversation.
    • The transcribed notes will be reviewed and verified by your clinician before being added to your medical records.
    • All notes, letters and transcriptions are securely stored and are only accessible to authorised personnel in our clinic, for a short period of time nominated by your clinician.
    • The information captured by Medow AI is treated with the utmost confidentiality in accordance with the Australian Privacy Principles and the Privacy Act 1988.
    • Your personal and medical information will not be shared with any unauthorised third parties.
    • You have the right to withdraw your consent at any time without affecting your ongoing care.

    By signing below, you acknowledge that you have read and understood the information provided above, as well as that provided verbally by your clinician.

    I consent to the use of Medow AI during my consultations and the transcription of my conversations for the purpose of medical documentation.*

    Consent

    By submitting this form, I acknowledge the Consulting Fees (including additional fees invoiced separately for allied health services in the Voice Clinic) and agree with my information being held by The ENT Clinic and/or Voice Clinic. Please contact the front desk staff prior to submitting this registration should you have any queries.*
    I am happy to be contacted to discuss possible research that I might be eligible for:*
    FEE Medicare rebate Out of pocket (estimate)
    New patient (104) $280.00 $84.15 $195.85
    Review (105) $180.00 $42.30 $137.70
    Endoscopy (41764) $240.00 $118.95 $121.05
    Phone Review (91833) $100.00 $42.30 $57.70
    Ear toilet (41647) $175.00 ($87.50 2nd ear) $106.45 ($53.25 2nd ear) $68.55 ($34.25 2nd ear)
    Nasal cautery (41677) $180.00 $87.20 $92.80
    Videostroboscopy (41501) $260.00 $179.70 $80.30
    Intratympanic steroids $255.00 $102.30 $152.70
    Skin Lesion Biopsy (30071) $150.00 $50.60 $99.40
    Oral Cavity Lesion Biopsy (45801) $300.00 $130.70 $169.30
    MEVT (Grommet) (41632) in chair $360.00 $231.25 $128.75
      *Fees correct from 01 July 2025 and may be subject to change without prior notice
    Fee Schedule