Patient Registration

A completed patient registration AND REFERRAL is required prior to making an appointment.

Once Dr Wines has reviewed your patient registration, clinical information and referral, we will contact you to make an appointment time.

There are two parts to registration. Part one is this form and includes the ability to upload your referral as an attachment. After pressing SUBMIT, you will be automatically redirected to a second form that involves getting details of your clinical history and reason for your appointment.