Please answer the following questions. You will have an opportunity to review your answers before sending them to us. If you see something highlighted in pink, it means that the question must be answered or corrected.
We like to communicate with our patients via email for clinical notifications. We will not give your email address out to anyone and it will only be used for "Wellend business".
Thank you very much for taking the time to fill out this questionnaire, and know that we look forward to seeing you soon.
If you would like to review your answers before you send it, please click the previous step button below, or alternatively, click the numbers circles above.
When you are happy, click submit button below.
I consent to Wellend Health Pty Ltd (ACN 161 970 396) collecting personal information relevant to my health and treatment and sharing this information with health care providers involved in my care. If you do not agree to Wellend Health Pty Ltd sharing your personal information across its affiliated health providers and other health professionals, we may be unable to provide services to you or we may be limited in the type or quality of services that we provide to you. All personal information is handled in accordance with relevant privacy legislation. I give my permission for my de-identified information to be used in research, development and commercialization of new medical therapies and devices as well as quality assurance purposes. I have read, and understood and have agreed to the above Privacy of Information Authority Statement.