FORMS

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For your convenience please find below a list of forms for printing out and submitting either at your appointment or by emailing/faxing them in advance of your appointment to: reception@pinesfamilypractice.com.au or Fax: 07 5598 2043

If you prefer to fill them out at the practice prior to your appointment, please arrive ten minutes before your scheduled appointment time to do so.

Practice Information Sheet

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This document contains information about our practice. it includes our opening hours, practice contact information, practice billing procedures, following up of test results, telephone calls to the doctors, repeat referrals and prescriptions and providing feedback and making complaints.

New Patient Form

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Our practice welcomes new patients.  When filling out this form, please fill in as much medical history as possible.

Transfer of Medical Records

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Are you a new patient of The Pines Family Practice and would like your medical records transferred to us from your other practice? If so, click below. Fill out this form so reception staff can request records on your behalf.

Patient Feedback Form

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At The Pines Family Practice, we are always looking for ways to improve the service provided to our patients at all stages of your visit. Below you can download a patient feedback form and submit it confidentially.

Fever in Children Handout

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Fever fact sheet – how to take your child’s temperature, treatment of a high temperature and at home care advice.

Healthy Kids Parent/Carer Questionnaire

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A Healthy Kids Check will include an assessment of your child’s height and weight, an assessment of their eyesight, hearing and oral health and discussion about their toilet habits and known or suspected allergies.  Please ensure this questionnaire is completed prior to the appointment.

Health Information Management Policy

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Practice Health Information Management Policy

  • The Pines Family Practice is committed to ensuring the privacy and confidentiality of all personal information affiliated with The Pines Family Practice’s business undertakings.
  • The Pines Family Practice follows the terms and conditions of privacy and confidentiality in accordance to the Australian Privacy Principles (APPs) as per schedule 1 of the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth), forming part of the Privacy Act 1988 (‘the Act’).
  • The purpose of this Privacy Policy is to clearly communicate how The Pines Family Practice collects and manages your personal information.
  • The point of contact regarding any queries regarding this policy is Rick McKee/ General Manager/ rmckee@pinesfamilypractice.com.au

The Pines Family Practice Complaint Form

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If unfortunately you are not satisfied with a service provided by one of our doctors or staff members please complete our patient complaint form and return to our practice manager. All complaints are given serious attention.