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FOREST LAKE LOCAL DOCTORS | BULK BILLING GP | GP DOCTORS IN FOREST LAKE

Dr San, Female GP | Bulk billing doctors in Forest Lake

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Request and Consent - Transfer of Medical Records

Patient name *

First

Last

Date of Birth *

My medicare card number *

Previous medical clinic name *

Patient Consent *

This request and authorisation applies to: *

Patient agreement *

Continue to Submit, only if you agree to this medical transfer request.

Our medical practice is proudly accredited by QPA (Quality Practice Accredited)

- Best Quality & Services -

BULK BILLING

TEL (07) 2111 9111 / FAX (07) 3607 2449

admin@forestlakelocaldoctors.com.au

Location: 4/85 Joseph Banks Ave, Forest Lake, QLD

Forest Lake, Inala, Richlands, Doolandella, Pallara, Heathwood, Durack, Darra, Ellen Grove, Camira, Oxey, Corinda, Sherwood, Graceville, Springfield, Spring Lake, Gailes, Algester, Rocklea, Acacia Ridge etc.

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