Dr Matthew Sherlock
Orthopaedic Shoulder and Elbow Surgery

New Patient Details Form


You may complete this online form prior to your appointment. It is sent via standard email security protocols. Alternatively, you may download a PDF copy. The completed form can be emailed to enquiries@shoulderspecialist.com.au or printed and brought in on the day.

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All appointments and enquiries 02 8403 8022

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Medicare Details

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ALL PATIENTS TO READ PLEASE


  • Settlement of your consultation account is required on the day, and payment for surgery within 14 days.
  • Any dishonoured cheques will incur administration fee of $15.
  • Any overdue consultation account and/or surgery account of 60 days will incur a $100 administration fee and over 120 days will be given to a collection agency (with your contact and account details) and will attract a 25 % service fee plus GST.
I accept responsibility for my accounts and agree to the above financial conditions.
Permission is given to release medical history to the family doctor, insurance company or solicitor.