Due to hospital upgrades there is very limited patient parking, please allow extra travel time for your appointment. Click here for more info.

New Patients

New Referrals and Appointments

If you are a new patient, please use the below new patient information form to request an appointment. Once completed our staff will be in contact with you to discuss an appointment time.

If you do not wish to complete it online, please have the information available on the day of your appointment as you will be asked to complete the form prior to seeing Dr Beattie.

Please visit our FAQs for information about the new patient process, locations and parking, and what to expect during your appointment.

Patient Referral Form

Patient Details

Title

Date of Birth

Month

Year

Surname

Given Names

Address

Address Line 1

Suburb

State

Post Code

Home Phone

Work Phone

Mobile Phone

Patient Medical Details

Preferred appointment location

Medicare No.

Medicare Reference No.

Pension?

Yes

Pension No.

Pension Expiry Date

DVA:

Yes

DVA Number:

Private Health Fund?

Yes

Private Health Fund

Private Health Fund Membership ID:

Usual General Practitioner

Emergency Contact Details

First Name

Last Name

Relationship to you:

Best Contact Number

Social History

Do you live

With Family

With Friends

Alone

Other?

Please outline where you live

Patient Medical History

Please list any previous urological procedures/intervention (if any):

Previous operations / procedures or hospital stays for illness with approximate dates:

Anaesthetic complications / post operative bleeding (if any):

Previous Medical Conditions

	Yes	No
Rheumatic Fever
Indigestion/Heartburn/Ulcer
High Blood Pressure
Epilepsy or Fitting
Heart Attack
Stroke
Chest Pain (Angina)
Thrombosis / DVT
Shortness of Breath
Pulmonary Embolus
Blackouts/Dizzy Spells
Anaemia/Blood Disorder
Thyroid
Asthma
Cancer
Diabetes Type 1
Diabetes Type 2
Gestational Diabetes

If yes, how many standard drinks per day?

If yes, how many standard drinks per week?

Medications and dosage

Are any of these medications prescribed for 'blood thinning' purposes?

Yes

Do you have any allergies?

Family History of Disease

Any other Medical History you think is important to your care:

I have read and agree to the Terms and Conditions and Privacy Policy

Hunter Valley Urology proudly provides excellent urological care to patients from the Hunter and surrounding regions, with locations in East Maitland and Gateshead.

	Yes	No
Hepatitis
Smoker
Alcohol

New Patients

New Referrals and Appointments

Patient Details

Patient Medical Details

Emergency Contact Details

Social History

Patient Medical History

Previous Medical Conditions

Head Practice

Site Links

Our Team

Practice Areas