CALL 03 9591 0714 Weekdays 9am - 5pm.
Southern Plastic Surgery
  • You’re In Safe Hands
  • Our Approach
  • Cosmetic Procedures
  • Reconstructive Procedures
  • Skin Rejuvenation & Skin Care
  • Blog
  • Contact Us

Patient Registration

  • Your Details

  • If patient is a child. If Guardian, please indicate your relationship to parent.
  • If different from local doctor.
  • General Health

    Please check all that apply.
  • Payments

    Please note Professor Coombs DOES NOT bulk bill.

    You will receive an account, which should be paid in full with the Secretary following your consultation. We can make the Medicare claim for you if required.

    The fees charged by this practice may exceed the Medical Benefit Schedule (MBS) Fee. They will not, in most instances, exceed the Australian Medical association (AMA) FEES.

  • Privacy Policy

    From 21/12/01, the Federal Privacy Act of 1988 has been amended to apply to all doctors in private practice. From 1/7/02 Southern Plastic Surgery will also be covered by the Health Privacy Principles as set out in the Health Records Act (Vic) 2001. The National Privacy Principles (NPPs) and the Health Privacy Principles (HPPs) require that fully informed voluntary consent is obtained before or as soon as practical after the collection of health information. This is particularly important for “secondary purposes” such as auditing surgical results and carrying out clinical research etc. These quality assurance activities should be a normal part of good surgical practice. Record keeping for plastic surgery may be in the form of clinical photographs. The privacy of individual patients is strictly maintained when reporting the results of audits or research to the medical profession. You may request access to your records. A summary of the NPPS and HPPs are available from reception. Please discuss any concerns you have about the privacy of your personal information with Associate Professor Coombs.

    By agreeing and submitting the registration form I accept that I have read, and understood the above and consent to patient information and photographs being used for the “secondary purposes” of audit and research by Southern Plastic Surgery.

  • Telehealth

    By submitting this registration form I also consent to consultations by telephone or video consultations where appropriate.

    I understand that I will be notified of the associated costs at the time of booking. I also agree to the medicare fee being claimed on my behalf after the consultation.

Contact us to request a consultation

Or just have a few questions?
Call 03 9591 0714
on weekdays between 9am - 5pm.

Alternatively, send us an email at: frontdesk1@southernplasticsurgery.com.au

Prefer us to call you

Fill out the form below and we'll get in touch at a time that works for you.
  • Our Approach
    • Your Consultation
    • Your Procedure
    • Your Recovery
    • International Patients
    • FAQs for you to consider
  • Cosmetic Procedures
    • Facial Rejuvenation
    • Nose Surgery
    • Ear Surgery
    • Body Contouring
  • Post Prostatectomy – Erectile Dysfunction
  • Reconstructive Procedures
    • Skin Cancer Treatment
    • Paediatric Hand Surgery
    • Hand Surgery
    • Facial Palsy
    • Complex Ear Problems & Microtia
  • Skin Rejuvenation & Skin Care
    • Intense Pulsed Light treatment (IPL)
    • Rationale Skincare
  • Patient Registration Form
    • Register Here
Copyright © Southern Plastic Surgery · Site and Strategy W3
Email frontdesk1@southernplasticsurgery.com.au