Child Benefits Schedule Bulk Billing Patient Consent Form

Patient Registration Form

Patient Registration Form

Parent Details

This section for parent's of children only

End children's section

Please read carefully and answer the following questions about your health and tick the relevant answer. Do you currently have or have you ever had any of the following:


Medical practitioners at Diggers Rest Medical Centre are committed to providing our patients with the best care. To do this it is essential that your health records are kept up to date and accurate. We recognise the importance of privacy and confidentiality for all our patients. Acknowledgement:

Person responsible for the fees

Payment Policy:

Our practice policy is to provide our valued patients with an estimate of their dental treatment cost before commencement. This may be completed verbally by our friendly dentists or nurses, and recorded in our notes, especially if urgent treatment is being performed.

As we are a private practice, payment for our dental service must be paid on the same day, otherwise will incur a fee of $75 for patients who do not meet these requirements.

We offer patients a range of payment options including:

  • Medicare (for eligible patients only)
  • Private Health Funds
  • DVA
  • Afterpay
  • ZIP

A non-refundable deposit may be required prior to major dental treatments.