Patient New Consult

Patient Registration

Title *

Legal First Name *

Legal Last Name *

Email Address *

Phone Number *

Address *

Street address *

City *

State *

Postcode *

What was your sex at birth? *

What is your DOB *

Do you have Medicare? *

YesNo

Medicare number *

Individual Reference Number *

Expiry Date: *

Do you have a IHI number? *

Also, have a link on how to find the IHI number
https://www.servicesaustralia.gov.au/how-to-get-individual-healthcare-identifier?context=22591

I agree to the Terms of Service and Privacy Policy, and consent to being contacted by Scripted Clinic for marketing and promotional purposes via email, SMS, or phone.

Thank you for completing the screening questions.

Unfortunately, based on your answers, you are currently not eligible for treatment with natural medicines through our clinic.

If you believe this may be an error, or you would like to discuss other options, please contact our team:

☎️ 1300 672 070

✉️ hello@scripted.clinic

We appreciate your understanding and are here to help if you have any questions.

New Consult Form

Patient Registration