New patient medical history form

  • 1 Current Introduction
  • 2 Contact details
  • 3 Medicare and health cards
  • 4 Previous skin cancers and conditions
  • 5 General medical history
  • 6 Risk factors
  • 7 Signature
  • 8 Complete
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Health Records Act 2001: Consent to collection of information

This form collects personal and health related information about you. By continuing to access this form, you give consent to Spot Check Clinic to collect this information. Please see our terms of service for more details on what information we collect and how it is managed.


Health Records Act 2001: Consent to collection of information

This form collects information about your medical history and risk factors for skin cancer. It helps us plan suitable tests, treatments and screening.

Information is stored in compliance with Australian health privacy legislation, i.e. encrypted and on servers in Australia. Medical records are available to Spot Check Clinic staff. Your clinical photographs and pathology results are also available to you via the DermEngine system.

Sometimes we need to share information with other health professionals and organisations, e.g. hospital clinics or medical specialists, your insurance company (at your request), or if required by law. On your written request, we can provide you with your medical information or forward it to another party.

Information may be used for professional development or research purposes within Spot Check Clinic. Where possible, we remove identifying information.

If you don’t provide accurate or complete information, it affects our ability to find and treat skin cancer and other conditions. Spot Check Clinic’s full privacy policy is available at


Please complete this form at least 24 hours before your first appointment.