Get Dr Jeremy Banky

Filling out the Dr Jeremy Banky form is an essential step for new patients seeking medical services. This guide provides clear, step-by-step instructions to assist you in completing the form efficiently and accurately.

Follow the steps to complete the Dr Jeremy Banky online form successfully.

1. Press the ‘Get Form’ button to access the Dr Jeremy Banky online form and open it in your preferred editor.
2. Begin by providing your personal details. Circle the appropriate title (Mr, Mrs, Master, Miss, Ms, Dr, Prof, Other) and fill in your surname, given name, and preferred name.
3. Enter your date of birth in the specified format (DD/MM/YYYY). Then, complete your address, suburb, and postcode.
4. Provide your email address and telephone numbers, including your home, work, and mobile. Indicate if you would like to receive SMS reminders for appointments.
5. Fill in the next of kin's details, including their name, relationship to you, and contact number.
6. Input your Medicare number, reference number, and expiration date, if applicable.
7. Indicate whether you have private health insurance by selecting yes or no, then enter the health fund name and membership number.
8. If you hold any concession cards, provide the necessary details including card numbers and expiration dates.
9. List your usual general practitioner’s name and practice details.
10. Answer whether you are allergic to any medicines, tapes, or latex. If yes, specify the allergies in the provided space.
11. Complete the authorization and consent to photography section. Sign and date where indicated to consent to the taking of your photographs.
12. Review the health records act collection statement and provide your signature and date to consent to the collection of your health information.
13. Indicate how you heard about Dr Jeremy Banky by choosing the relevant option and providing any additional information where necessary.
14. Finally, save your changes. You can then download, print, or share the completed form as necessary.

Complete the Dr Jeremy Banky form online today to facilitate your healthcare journey.