New Patient Form

Complete the new patient form online prior to your first consultation

    Do you have Hospital Insurance?

    Have you had insurance for more than one year?

    Patient Privacy Policy Patient Privacy Policy (55 KB)

    Privacy Policy

    Peninsula Obstetrics & Gynaecology takes its obligations under the Victorian Health Records Act 2001 and under the Commonwealth Privacy Act 1988 seriously and therefore we try to take all reasonable steps to protect the privacy of the personal information we hold.  This policy sets out how we intend to do so.

    Collection of Information.

    • It is necessary to collect and hold your personal health information in order to assess, diagnose you, treat and be pro-active in your health care needs.

    • This information will be obtained directly from you and from your other treating doctors.

    • Members of the professional team involved in your health care will have access to this information.  This means we may disclose the information you provide for:

    • other treating doctors including your general practitioner, other specialists involved in your care, pathologists and radiologists.

    • medical disease registers where appropriate (e.g. Pap smear Register).

    • administrative purposes in running our medical practice e.g: our medical indemnity insurer, quality assurance and accreditation bodies.

    • billing purposes, including providing information to your health insurance fund, Medicare, and other organizations responsible for the financial aspects of your care. 

    • conducting professional research.

    • assisting with training and education of other health professionals.

    • Some information we collect is in order to comply with our legal obligations.


    We will take all reasonable steps to protect the security of the personal information that we hold.  This includes appropriate measures to protect electronic data and hard copy material.  We do not contract out any data storage functions.

    Information Quality

    Our goal is to ensure that your information is accurate, complete and up to date.  To assist us with this, please contact us if any of the details you have provided change.  Further, if you believe that some of the information we hold about you is not accurate or up to date, please contact us and we will use all reasonable efforts to correct the information.


    You are entitled to have access to your health records.  This means that you can inspect your record.  You can receive copies of letters we have written and of results of tests done.  You can also view the record and have its contents explained, with adequate notice.

    At the same time, we are entitled to charge you for you time involved in providing this service.  This might, for example, be the cost of the consultation or might be photocopying costs.

    We do not routinely provide written summaries of medical records over and above copies of letters already written to referring doctors.  Where summaries are specifically needed by a patient, fees will be generated in line with medico-legal practice.  As these are expensive a quote will be provided in advance.

    All requests for access to your records will be treated seriously, dealt with promptly and in a confidential manner.  To obtain access you will have to provide proof of your identity.  This is necessary to ensure that your personal information is only provided to you, and that the privacy of others is also preserved.  You should be aware that the medical record that we hold remains our property and cannot be removed from the clinic or passed on to others.

    There may be occasions when a request for access to a medical report may be denied.  Access will be denied if:

    • the request does not relate to the personal information of the person making the request.

    • providing access would pose a serious and imminent threat to life or health of a person.

    • providing access would create an unreasonable impact on the privacy of others.

    • the request relates to legal proceedings between our doctors and you.

    • access would be unlawful.

    • access would prejudice law enforcement activities, the request is frivolous and vexatious.


    If you have any complaints about our privacy practice or wish to make a complaint about how your personal information is managed, please contact Marion Stephens, our Office Manager.  We prefer that you complaint is in writing.  All complaints will be dealt with fairly and as quickly as possible.  If you are dissatisfied with the outcome of our handling of your complaint, you may contact the Victorian Health Services Commissioner or the Federal Privacy Commissioner.

    What happens if you choose not to provide us with information about yourself?

    You are not obliged to provide us with your personal information.  However failure to provide us with important information about your health my compromise the quality of care we provide and the treatment given to you.

    Disclosure of your information to family members and friends?

    In general we will only disclose your health information, such as test results, directly to you, the patient.  Occasional exemptions occur, such as in emergencies.

    • Practice policy is for payment on the day of consultation.

    • If this account is not paid within 30 days, an accounting fee may be added to the account. Should your account present you with a genuine financial problem, please discuss this with Dr Marshall's secretary.

    • I acknowledge that my personal information may have to be disclosed to, or collected for Government & Health Fund statistics or to other treating health professionals so that my health care is not compromised. It will however be disclosed to other organisations where required by law or if necessary for debt recovery purposes.