Patients of Dr Emmanuel Varipatis:
NEW PATIENT FORM:
NPQ New Patient Questionaire (please right-click and download/print the form)
If you are a new patient and have made a booking with Dr Varipatis, please click on the above link to download and fill out the ‘new patient questionaire’. Once completed, please send it through to firstname.lastname@example.org or give to reception at your first appointment.
EXISTING PATIENT FORM FOR MEDICAL RECORD TRANSFER:
Avenue Road Medical Record Transfer Request (please right-click and download/print the form)
If you are an existing patient of Dr Varipatis from Your Health or Avenue Road Practice, please click on the above link to download and fill out the ‘Medical Record Transfer Request’.
Once you have completed the form, you will need to call Avenue Road on 02 9968 2222 to make payment of the $45 admin transfer fee and email the signed form to email@example.com. This fee is Avenue Road’s administration fee for processing your file, unfortunately we do not have any influence over the cost of the transfer nor the time it takes as this is determined by Avenue Road. Please note, your file may take 1 to 2 weeks to be transferred.
Novavax Consent Form:
We are now offering Novavax Vaccine as a primary and booster vaccine. Please call reception to book your appointment. Then complete the following form and send to firstname.lastname@example.org
COVID-19 VACCINATION: – Covid-19 Consent Form (please right-click to download the form)