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    • Medications to Stop Prior to Surgery
  • Contact Us
  • Home
  • About us
    • Our Practitioners
    • Our Staff
    • News
    • Ear Nose Throat Newcastle Gallery
  • For Patients
    • Patient Registration
    • Your First Visit
    • Telehealth
    • Paediatric Speech & Voice Clinic
    • Frequently Asked Questions
  • For Referrers
    • Conditions We Treat
    • Audiology Services
    • Guidelines For Tonsillectomy
    • ENT Education
      • ENT Education
      • GP Educational Talks
    • Publications & Research
  • Your Operation
    • Your Operation
      • Everything you need to know
      • Grommets
      • Tonsillectomy
      • Adenoidectomy
      • Septoplasty + Sinus Surgery
      • Skin Lesion Excision
    • Your Private Health Cover
    • No Health Insurance?
    • Medications to Stop Prior to Surgery
  • Contact Us

Patient Registration

1 Patient Details
2 Account Information
3 Privacy, Billing and Consent
  • Do not complete this form unless you have a confirmed appointment at Ear Nose Throat Newcastle.
  • Patient Details

  • Please put the day of expiry as the last day of the month
  • Account Holder Details

    Please fill out account holder details below for Medicare claiming purposes
  • (1 digit next to cardholder's name)
  • Please put the day of expiry as the last day of the month
  • Emergency Contact

    Must be different from the details entered above
  • Emergency Contact

  • Family Members

  • Please list one family member per line
  • Pension Card Details

  • Health Care Card Details

  • DVA Membership

  • Dr. Jefferson is unable to book patients on to public operating lists from his private rooms. If you are not privately insured and not in a position to pay for surgery out of pocket please let our receptionists know. They will forward your referral onto the public outpatient clinic at John Hunter Hospital for you to be seen through the public system instead.
  • Health Fund Details

  • I understand that the practice keeps my information safe and secure in accordance with the national guidelines. To read our privacy policy click here. I understand that my information may be disclosed to other individuals involved in my health care outside of this practice
  • I understand that payment is required on the day of service via cash, EFTPOS or cheque. And that failing to attend will incur a fee

    Initial Consultation: $230.00 (medicare rebate $73.85)
    Initial Pensioner Consultation: $185.00 (medicare rebate $73.85)
    Follow up Consultation: $120.00 (medicare rebate $37.15)
    Follow up Pensioner Consultation: $95.00 (medicare rebate $37.15)

    Any procedure performed during the consultation will incur extra fees.
    The fees charged for any procedures will be fully rebated through Medicare.
    I agree to pay any and all fees associated with my consultation
  • I agree to be bulk billed for any procedures performed by Dr Niall Jefferson in his private rooms, with a valid Medicare card and referral
  • We are committed to the highest level of security for our patients. This photo will be stored securely and will not be shared outside of your medical record. Upload a photograph now for your medical file.
  • Dr Jefferson may take photos inside of your ears, nose or throat. These photos are stored securely within your medical record. These photos do not contain any identifying features. Dr Jefferson may use these images for teaching purposes without your name attached.
  • Ear Nose Throat Newcastle love ensuring that our social media and website are kept up-to-date. If our staff see a photo opportunity whilst you are in the practice, would you be happy for your photo to be used on our social media pages and website?
A little bit about us

Dr Jefferson is a passionate Ear Nose and Throat Surgeon.

He and his team are dedicated to the highest level of care every step of the way.

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Contact Us
  • Suite 1, 67 William St
    Jesmond NSW 2299
  • 02 4955 8044
  • 02 4955 8055
  • admin@entnewcastle.com.au
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