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  • Bowel Cancer Screening
  • Services
    • Endoscopy
    • Rapid Access Endoscopy
    • Consultations
  • For Patients
    • For Patients
    • Appointments
    • Procedure Information
    • Handouts
    • Links
    • Practice Policies
    • FAQs
    • Make a payment
  • For Doctors
    • For GPs
    • For Specialists
    • Referral Forms
    • Procedure Information
  • Resources
    • Media
    • Publications
  • About
    • Sydney Gastroenterology
    • Your Team
    • A/Prof Darren Pavey
  • Contact Us

Patient Information and Consent Form

Date: 09 May 2025

To get started, please complete the below fields and click next to proceed.

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Patient Information

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Address
(please provide at least two telephone numbers for contact purposes)
Is this person authorised to discuss your medical information?
Is this person authorised to discuss your medical information?
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Collection of Personal Information

This medical practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and medical history so that we may properly assess, diagnose, treat and be proactive in your health care needs. We will use the information you provide in the following ways:

  • Administrative purposes in running our medical practice.
  • Billing purposes, including compliance with Medicare Australia requirements.
  • Disclosure to others involved in your health care, including treating doctors and specialists outside this medical practice as advised by you.

To comply with the Privacy Act 2001, all patients need to provide consent for the above aspects of their medical care. Staff are bound by strict confidentiality requirements. Please be aware that we only keep scanned computer generated copies of your original documentation. All non-returned original documents are disposed of securely within 24 hours of your appointment. To assist in our administrative practices, please be aware that we use information software applications, including artificial intelligence. Please be aware that we do not routinely send correspondence and reports to My Health Record.

Communication by email

Sydney Gastroenterology offers patients the opportunity to communicate by email for non-urgent administrative matters.  Please find below the risks and guidelines for email communication.

Communication by email has a number of risks which include, but are not limited to, the following:

  • Email can be circulated, forwarded and stored in paper and electronic form.
  • Back up copies of email may exist even after the sender or recipient has deleted his/her copy.
  • Email can be received by unintended recipients.
  • Email can be intercepted, altered, forwarded or used with authorisation or detection.
  • Email can be used to introduce viruses into computer systems

Guidelines for Communication

  • Include the general topic of your message in the subject line of your email (eg appointment)
  • Include your name, date of birth and phone number in the email
  • Email should be used for non-urgent administrative issues only. 
  • It is your responsibility to notify Sydney Gastroenterology of any changes to your email address
  • Sydney Gastroenterology will try to respond as soon as possible but not within any particular timeframe
Communication by SMS

Sydney Gastroenterology offers patients the opportunity to receive non-urgent administrative SMS messages for appointment reminders, recalls and other reminders or medical services we offer.  It is your responsibility to notify Sydney Gastroenterology of any changes to your mobile phone number.

PATIENT CONSENT
  1. I understand the reasons why my personal information must be collected.
  2. I consent to the practice collecting information relevant to my condition from other medical practitioners such as GPs, specialists, health care providers, pathologists, radiologists, hospitals or day surgeries.
  3. I understand that I am not obliged to provide any information requested of me, but that not doing so might compromise the quality of the health care and treatment given to me.
  4. I am aware that I may apply to access my health records.
  5. I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure of which I may notify this practice.
6. I understand the risks and guidelines associated with email and agree to give consent for email communications to and from Sydney Gastroenterology.
7. I understand and agree to give consent to being contacted via SMS (mobile text message)
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Patient Health Questionnaire

PLEASE ANSWER EVERY QUESTION.
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        Do you smoke? Please tick one option and provide the details if required*
        Do you drink alcohol? Please tick one option and provide the details if required.*
        Do you smoke marijuana or use any other substances?*
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        This field is for validation purposes and should be left unchanged.

        LOCATIONS

        CHRIS O’BRIEN LIFEHOUSE

        Clinic D, Level 2
        119-143 Missenden Road
        Camperdown NSW 2050

        MAP

        Macquarie University Hospital

        3 Technology Place
        Macquarie University
        NSW 2109

        MAP

        ST GEORGE PRIVATE HOSPITAL

        1 South Street
        Kogarah

        MAP

        logo

        Chris O’Brien Lifehouse
        119-143 Missenden Road
        Camperdown NSW 2050

        P 02 9707 3523
        F 02 9709 5637

        reception@sydneygi.com.au

        Copyright © 2022 Sydney Gastroenterology | Privacy Policy | T&C's | Contact Us

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        We are operational and here for you.

        • Many of our patients and referring doctors have asked if, and how, COVID-19 will affect their care with us. We would like to reassure you that we continue to offer our specialist services, consultations and procedures and have adapted our usual practices to best accommodate the current health-safety needs of all our patients, staff and the larger community.

          Sydney GI remains fully operational and has the technology, infrastructure and systems to continue practice in these unusual times. For our patients and referring doctors, there will be little noticeable difference in how we communicate and manage our patients’ care. We continue to take all reasonable precautions to protect our patients and staff and therefore offer video- or telephone-calls for all appointments at this time.

        • Despite COVID-19 being an ongoing concern, our GI patients must still receive timely and appropriate care and we continue to serve this directive. While the private endoscopy centres and day surgeries remain open for Category A (urgent) patients, we continue to run procedures for these patients under rigorous wellbeing and hygiene protocols. The doctors at Sydney GI will discuss the needs of each patient and any risks or concerns associated with having a procedure in this current environment.

          As the situation with COVID-19 continues to change, we will post updates on our website and notify patients and doctors as we can. In the meantime, we are here and continue to support you in health. If you are concerned about your GI health, if you have questions or would like an appointment, (02) 9707-3523 or email us at reception@sydneygi.com.au.

          For official government updates on COVID-19 please check their website on www.health.gov.au.