Patient Registration Forms, including:

  • Patient Information
  • Consent To Release Medical Information
  • Patient Health Questionnaire (an overview of your: Medical History, Issues & Medications)
  • Privacy Statement, Patient Agreement & Cancellation Policy

Hospital Registration
If you have been booked for delivery or surgery at the Cairns Private Hospital or the Cairns Day Surgery, with Dr. Elizabeth Jackson, please complete your hospital registration forms.

Menstrual Diary
If you experience pelvic pain or period issues, please try to complete this diary before your appointment

Fertility Form
If you are planning on pregnancy and wish to discuss this with us, please try to complete 1-3 months (no greater than 6 months), prior to your appointment

Bladder Diary Form
If you experience bladder related issues, please try to complete this form before your appointment

Have you registered for MyHealth?
My Health Record is the Australian Government's secure online summary of your health information. You can control what goes into it, and who is allowed to access it. You can choose to share your health information with your doctors, hospitals and other healthcare providers.