New Patient Form

New Patients: Please complete this form, and we will contact you to arrange an appointment
Existing Patients: Please call or email to arrange your next appointment

First Name

Last Name

Date of Birth

Gender

Male

Female

Home Address

Phone

Medicare Number

Position On Card

Referring Doctor

Please upload a photo of your referral (if you have one)

Photo

Please upload a PDF of your referral (if you have one)

PDF

Emergency Contact / Next of Kin - Name

Emergency Contact / Next of Kin - Phone

Emergency Contact / Next of Kin - Email

Who are you seeking to make an appointment with?

Dr Rowena Mobbs. Specialist in cognitive disorders including dementia, Alzheimer's disease, CTE, concussion, headaches, migraine, and Botox therapy.

Dr Alex Fois. Specialist in movement disorders including Parkinson's disease, Lewy body disease, epilepsy, motor neurone disease, multiple sclerosis, neuropathy, tremor, dystonia, restless legs syndrome and Tourette syndrome.

Either. For general neurology

Are you seeking to make an appointment as:

Private patient (Medicare rebates apply after full payment)

Workers Compensation, CTP, NDIS, etc. paying the doctors fee

Defence or DVA

Terms and Conditions

1) Harbour Neurology will document a complete history of my medical conditions and management. 2) Harbour Neurology can obtain relevant information from other medical practitioners, healthcare providers, and My Health Record. 3) Harbour Neurology can share relevant information with other medical practitioners, healthcare providers and My Health Record.

I agree to the terms & conditions

Thank you! We will be in contact shortly

New Patients: Please complete this form, and we will contact you to arrange an appointment
Existing Patients: Please call or email to arrange your next appointment

Phone: (02) 9900 5500
reception@harbourneurology.com.au

Level 6/53 Walker Street
North Sydney 2060

EDI: HealthLink (harbourn)
or Medical Objects

New Patients: Please complete this form, and we will contact you to arrange an appointment Existing Patients: Please call or email to arrange your next appointment

Phone: (02) 9900 5500 reception@harbourneurology.com.au

​​Level 6/53 Walker Street North Sydney 2060

EDI: HealthLink (harbourn) or Medical Objects

New Patients: Please complete this form, and we will contact you to arrange an appointment
Existing Patients: Please call or email to arrange your next appointment

Phone: (02) 9900 5500
reception@harbourneurology.com.au

Level 6/53 Walker Street
North Sydney 2060

EDI: HealthLink (harbourn)
or Medical Objects