Patient Registration

Please complete the following questions prior to your appointment

First name

Mobile/Phone number

Last name

Date of Birth

Occupation

Home address

Medicare number

Private fund eg. BUPA/HCF

Medicare reference number

Medicare expiry date

Private fund membership number

Workers compensation/CTP claim number and Case manager details

Emergency contact name

Parent/guardian/carer name and phone number

Emergency contact number

Parent medicare number and reference number, expiry date

Have you had any imaging performed? Please enter the location (ie. Lumus/Synergy/IMed) and accession number if you have it.

Referring doctor/physiotherapist name and address

GP name and address

Interpreter required? Please write down which language you speak.

What problem do you have? How long have you had this for?

I declare that the info I’ve provided is accurate & complete and am happy for Dr Jang to use this information for my treatment and care.

Patient registration

Dr Bob Jang
Orthopaedic Surgeon
BMed FRACS FAOrthA

Practice Locations

Orthocentre

Bankstown Hospital Medical centre

Operating Locations

Kareena Private Hospital

North Strathfield - SportsFizz

Bankstown Lidcombe Hospital

Patient registration

Dr Bob Jang Orthopaedic Surgeon BMed FRACS FAOrthA