Patient Registration

Welcome to Knox High Risk Foot Clinic. Please complete your registration to help us provide you with the best possible care for your foot health needs.

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Before Your Visit

To ensure we can provide the best care, please bring:

Medicare card and any private health insurance cards
Referral letter from your doctor (if available)
List of current medications
Previous medical records related to your foot condition
Recent pathology or imaging results
Comfortable, easy-to-remove footwear

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Appointment Information

What to expect during your visit:

Initial consultation: 45-60 minutes
Comprehensive foot and vascular assessment
Discussion of treatment options
Coordination with your existing healthcare team
Follow-up appointments as needed
Detailed care plan provided

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Our Location

Knox High Risk Foot Clinic is conveniently located at:

Suite 10A Knox Private Hospital
262 Mountain Highway
Wantirna Victoria 3152
Ample parking available on-site
Accessible facilities
Public transport accessible

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Payment & Insurance

We accept various payment methods:

Medicare (bulk billing available for eligible patients)
Private health insurance
DVA (Department of Veterans' Affairs)
EFTPOS and credit card payments
On site health insurance billing via Tyro

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Privacy & Confidentiality

Your privacy is important to us:

All information is kept strictly confidential
Secure electronic health records
Information shared only with your consent
Compliance with Australian Privacy Principles
Right to access your medical records
GDPR compliant data handling

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Contact & Support

We're here to help with any questions:

Phone: (03) 8362 3780
Email: admin@vascularsurgeons.com.au
Online appointment booking available
Appointment reminders via SMS/email
Disability access and support

Patient Registration Form

Please complete the registration form below to help us prepare for your visit and provide personalized care tailored to your needs.

Please enable JavaScript in your browser to complete this form.

- Step 1 of 4

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Allergies allergies? upload

Name of General Practitioner *

First

Last

GP Practice Name *

Referring Doctor (if not your usual GP)

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Emergency Contact Relationship *

Medicare or DVA Number *

Medicare Reference Number

Do you have private health insurance? *

Level of Coverage

For vascular procedures, generally silver cover or higher is required for in hospital treatment. Outpatient podiatry services can be included on any level of coverage (ie gold/silver/bronze). To save time, consider checking your level of coverage prior to visiting our practice.

Health Fund

Fund number

Pre-existing conditions *

High Blood Pressure
Previous heart attack/chest pain
High cholesterol
Previous stroke or mini stroke (TIA)
Diabetes
Kidney Disease
Blood clotting problems
Problems with anaesthesia (or family history of)
Cancer
Chronic infections
Other (please describe below)
None of the above

Other

Current medications and natural therapies *

Do you have any allergies? *

Allergies

How did you hear about us? *

If other, please describe

Do you consent to our practice submitting claims to medicare on your behalf?

Referral upload

Click or drag files to this area to upload. You can upload up to 20 files.

⚠️ Important Notice

If you are experiencing a foot emergency such as severe infection, sudden loss of sensation, or signs of serious circulation problems, please seek immediate medical attention.

Call 000 for Emergencies