Hyde Park Medical Centre

Ground Floor,Shop 1,175 Liverpool St

Sydney, NSW 2000

Phone : (02) 92831234 / 80785100

Fax : (02) 92830303

Email : admin@hydeparkmc.com.au

ONLINE RESULTS REQUEST + OTHERS

Online Results Request + Others only available for existing patient

1 TERMS AND CONDITIONS

Please read the following Terms and Conditions :

By using our Online Results Request + Others, you are agreeing to be bound by the following terms and conditions.

1. Results will be released from online requests upon the Doctor's discretion. If results cannot be released online, the patient is required to make an appointment to see the Doctor to get the results in person. If the online result request is accepted, only the results will be disclosed. If the patient wants to discuss the results, they will need to make an appointment to see the doctor. It is the patient's responsibility to make arrangements to see a doctor for their ongoing health care requirements.

2. Please be advised, Hyde Park Medical Centre and its doctors do not have the right to release specialist reports, third party paperwork and hospital documentation without written consent from the writer.

3. The fee for all requests is $30.00 through PayPal or Visa/Master Card. Obtaining an approved Online Results involves multiple clinical and administrative steps therefore NO REFUND will be made for declined requests.

4. Online result requests + Others are directed to and reviewed by the requesting doctor when they are next consulting in the centre. Delays in request completion may occur when the Doctor is unavailable or is on leave, or the centre is closed. If in the case that the patient requires the result urgently, the patient should NOT submit an online result request and should contact the centre directly to make an appointment with the next available doctor.

5. By submitting this request, the patient understands that fax, email and digital correspondence is not encrypted and is not secure. The patient agrees to the release of Hyde Park Medical Centre from any liabilities associated with any breach or loss of your medical records released via electronic platforms.

6. Patients should also be aware that no refund will be given if requests are cancelled, declined, or lost, or if they have made an error or changed their mind.

DECLARATION

I have read, understand and accept the above terms conditions.

2 PATIENT DETAIL

Please choose an options :

Patient Number :

First Name :

Last Name/Family Name/Surname :

A Medicare Number :

B Ref. Number :

Date of Birth : (DAY / MONTH / YEAR)

Mobile : (e.g. 0499990112)

Email Address :

3 RESULTS REQUEST

Please choose an options :

Which doctor review your request :

Please provide date of results/records and description :

Reason for the request :

Where the result send to :

Delivery Method :

Recipient's Email Address :

Recipient's Note on Email :

Recipient's Name :

Recipient's Fax Number :

4 SUBMISSION

By clicking the Submit button, you will redirect to PayPal website for Credit Card / Paypal payment.

Total Amount Paid : $30