Patient Registration Form

Dr Simon Elix - Orthopaedic Surgeon

Completing this online registration will email your information directly to the rooms. A copy is also sent to the email address nominated in the form.

Please complete at least one contact phone number.





If patient is a minor (under 18)


Workers Compensation (if applicable)


FINANCIAL INFORMATION

Medicare does not completely cover the cost of your consultation. The consultation fee’s charged by Dr Elix are as follows and are payable IN FULL on the day of consultation by EFTPOS only. No cash is kept on the premises.

Initial Consultation - $200.00 ($75.05 rebate) Review Consultation - $110.00 ($37.70 rebate)

Deviation to the above fees may occur e.g. Second opinions and multiple injuries subject to the Doctors discretion. Other fees may be incurred for plaster casts, boots, injections, splints etc. It is a term of the provision of these services that the patient shall be liable for all debt collection fees and charges if required. I understand that payment of the account in full is my responsibility (not applicable for accepted Workcover claims, Defence Personal, DVA card holders).

CONSENT

I consent to the release and communication of information from or to any other medical provider for the purpose of my ongoing clinical management, ongoing clinical care and audit.

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We would love to hear from you. Please call us or make an online enquiry.

7 Madsen Medical
Opposite Hervey Bay Hospital
Hershel Court
Urraween QLD 4655


Monday – Friday
8:30 am – 5:00 pm


Free parking is available in front of the clinic.


Buses 1A and 5 stop on Nissen St outside the Hervey Bay Hospital campus. It is a 5 minute walk to Madsen Medical. For timetables visit Wide Bay Transit or call 07 4128 6411.


The ground floor clinic is fully accessible.

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