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Patient Forms

We require some information to communicate with you or your family, with other doctors involved in your care, and to provide information to Medicare and Medical Insurance Funds on your behalf.

This is usually requested at your first appointment. Please allow 10 – 15 minutes to complete the forms.

If your details change please let us know.

For convenience the Patient Information Form can be downloaded and filled out before you come.

pdfPatient Information Form

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Dr Baker’s Privacy Policy

Vascular Surgery WA complies with the Privacy Act (2001) and as part of their Privacy Policy, they are committed to protecting the privacy of individuals and their personal information. The purpose of collecting personal information is to provide quality medical and health related services and associated account keeping. Patients have the right to request access to their own information except where access would be denied. Vascular Surgery WA and Dr Baker make every effort to manage information in accordance with the National Privacy Principles and keep records up to date and accurate. Patients may withdraw consent for Vascular Surgery WA to use and disclose personal information (except when legal obligations must be met).

Agreeing to Vascular Surgery WA and Dr Baker’s Privacy Policy indicates that consent is given to:

  • Dr Baker collecting, using, storing and disposing of personal information.
  • The release of relevant personal information to other health professionals (e.g. Specialists, etc.).
  • In the case of a work related consultation or service, the release of relevant personal information to an employer, their authorised representative, and their insurer.