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Fields marked with an * are mandatory.

Registration Form

  1. Please complete the following details
  4. Gender*
  5. Title*
  6. Status*

Medicare Card Holders

  1. If you hold a Medicare card, please complete relevant details.

International Students

  1. If you are an International student, please complete relevant details.

Extra details

  1. Please complete your relevant details.
  2. Are you of Aboriginal or Torres Strait Islander Descent?
  3. If you are a non Swinburne international student please contact the Health Service directly.

Privacy statement

  1. I understand that my medical history and consultation will be confidential. However, legal compliance requires that if the medical staff are concerned about my safety or the safety of others, then this confidentiality may be broken. Records may be subpoenaed for court in exceptional circumstances. I understand that my confidential records remain the property of Swinburne University of Technology's Student Services. I may request to view my personal information in these records. Swinburne Health Service values and is committed to the privacy of its clients. Please refer to: http://www.swinburne.edu.au/privacy.htm and http://www.privacy.gov.au/business/health
  2. I agree*
 

Health Registration
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Register in advance online, and have records on file for when you may need to use the Hawthorn Health Service.

Fields marked with an * are mandatory.

Registration Form

  1. Please complete the following details
  4. Gender*
  5. Title*
  6. Status*

Medicare Card Holders

  1. If you hold a Medicare card, please complete relevant details.

International Students

  1. If you are an International student, please complete relevant details.

Extra details

  1. Please complete your relevant details.
  2. Are you of Aboriginal or Torres Strait Islander Descent?
  3. If you are a non Swinburne international student please contact the Health Service directly.

Privacy statement

  1. I understand that my medical history and consultation will be confidential. However, legal compliance requires that if the medical staff are concerned about my safety or the safety of others, then this confidentiality may be broken. Records may be subpoenaed for court in exceptional circumstances. I understand that my confidential records remain the property of Swinburne University of Technology's Student Services. I may request to view my personal information in these records. Swinburne Health Service values and is committed to the privacy of its clients. Please refer to: http://www.swinburne.edu.au/privacy.htm and http://www.privacy.gov.au/business/health
  2. I agree*

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