Sydney Children's Sleep Disorders Clinic
Dr Arthur Teng & Associates

Registration form

Make an appointment

Complete your patient registration

Prior to your appointment, please complete the patient registration below and return it to our office with your referral letter. This will allow more time with your doctor. On the day of your appointment, please bring your referral letter and Medicare card. Confidentiality is maintained at all times.

You can also email or fax the printable version of the Patient Registration Form to our office. See form for email and fax details.

Child details
Name *
Name
Name of the child
Date of birth
Date of birth
The child's date of birth
Family details
Address *
Address
Home address
Mother's name *
Mother's name
if the surname is different the child's, please specify.
Father's name *
Father's name
Refer
The referring doctors details
Referring Doctor *
Referring Doctor
Referring Doctor's name.
Address *
Address
Address of the Referring doctor
Date referred *
Date referred
Local Doctor
Local Doctor
Name of your local doctor, if different to the referring doctor.
Local Doctor's address
Local Doctor's address
Medical information
The number next to your name on the Medicare card.
Medicare expiry *
Medicare expiry
Pension expiry
Pension expiry
Name of your health fund.
Your private health memebership number
Please list all your child's allergies.MR
(if applicable)
Medicare rebate
You can claim Medicare rebate from our office. This means that you pay your account in full at the time of your consultation and our reception staff transmits the claim directly to Medicare. The rebate is paid to you by Medicare by either EFT or cheque. If you would like to receive an EFT payment, please provide the details below.
Parent's name
Parent's name
Date of birth
Date of birth
DOB of the parent
The number next to your name on the Medicare card
Please bring your referral letter and Medicare card on the day of your appointment.