Health Questionnaire

To assist us with your consultation please complete the following online form prior to your appointment.

Alternatively, you can download a PDF of the form to complete manually here – Health Questionnaire







    Medical Conditions

    Do you have or have you ever had, the following conditions?

    Medical History

    Your Privacy, Our Concern – Consent to use your personal information

    Dr Ian Baxter and The Sunshine Coast Medical Weight Loss Centre complies with the Commonwealth Privacy Act and all other state and territory legislative requirements in relation to the management of personal information. We collect information that is necessary for the provision of your health care. Personal information obtained from you in your consultation may be used to provide information to various health services involved in supporting your health care management (e.g. pathology, radiology, hospitals or other specialists).

    I have read and understood the Privacy Policy and understand my rights and responsibilities.


    SIPPY DOWNS
    Atria Building

    Suite 6, 44 Central Drive
    Sippy Downs QLD 4556


    MORAYFIELD
    Health Hub Morayfield

    19-31 Dickson Road
    Morayfield QLD 4506


    GYMPIE
    Gympie Specialist Clinic

    2/71 Channon St
    Gympie QLD 4570


    CONTACT US

    Tel: (07) 5444 8594
    Fax: (07) 5444 8549


    OPENING HOURS

    Monday-Thursday: 8.30am to 4.30pm
    Friday: 8.30am to 3.00pm

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