Spotfix Registration Form – Windsor Gardens Dermatology

From here you can book your appointment

Spotfix Registration Form

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Spotfix Registration

Please complete the below form to start your booking process.

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Full Name

First

Last

Mobile Number

Email Address

Date Of Birth

Medicare Number

Medicare Reference

Medicare Expiry Date

How long have you had acne?

Where does your acne affect you?

What have you tried so far that is prescribed by your doctor?

Do you take regular medications? If yes, please specify

Do you have any allergies to medications? If yes, please specify

What is your occupation, or if you are student, what are you studying?

other steroids Birth

Your identity

Click or drag a file to this area to upload.

Please provide clear photographs of your face +/- torso including a shot from the front, right side and left side (uploading facility)

I agree to Windsor Gardens Dermatology Privacy Policy outlined below

Windsor Gardens Dermatology is bound by the privacy Act 1988 and the National Privacy Principles, and deals with personal information in accordance with such principles. For further information regarding your privacy and your rights to your medical information please call our clinic on (08) 7130 0152. Clinical photographs are routinely needed to assist us in your treatment. There are only kept in your personal notes and are never used for any other reason. Please discuss with your doctor any questions you may have about this. From time to time, it is necessary for us to share your clinical details with other relevant practitioners. Please discuss with your doctor any questions you have about this

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WINDSOR GARDENS DERMATOLOGY 2025 BUILT BY ÉLEVÉ STUDIO