New Patient Application Form

This practice believes in providing best practice evidence based care.
We expect patients to adhere to our immunisation and chronic disease management policies.


* required fields  
*Full Name:
*Date of Birth:
*Email address:
*Postal Address:
Other Family Members:  
Name: DOB:
Name: DOB:
Name: DOB:
Name: DOB:

Immunisation history up to date     Yes      No

Please bring children's immunisation records to initial consultation.
Private Health Fund
Pension/Health Care Card No
Recently moved to Bundaberg    
Currently attending a General Practice 
Same Day Appointment Requested 

Note that same day appointments will only be considered if clinical need. Please provide reasons e.g. sick child, in comments box.

We will notify you within 24 hours of the result of your application. Requests for same day appointments will be notified same day.  Be aware that there is a very limited capacity to provide urgent appointments.

Alexandra Park Medical Centre

60 Quay Street
Bundaberg Qld 4670

Tel: (07) 4152 5477

We are a small practice and so we take a limited
number of new patients - refer to contact page.