New Patient Registration

/ New Patient Registration

Patient Registration Form

Begin your journey by completing the patient registration form below. Once registered, you’ll receive and information pack containing everything you need to know before you book your consultation. Please check your junk or spam folder if you do not receive this in your inbox.

Step 1 of 4
Registration Type**
Patient's First Name**
Patient's Surname**

Step 2 of 4
Patient Email**
Patient Phone Number**
State/Territory
Postcode**
Carer Name**
If you are registering for someone else, you are the carer. Please provide your full legal name (first name and surname)
Carer Phone**
Consultation notifications are provided via SMS / Text Message. This will be used as the primary phone number
Carer Email**
Please provide your email address for consultation information, information resources and booking confirmations.

Step 3 of 4
Please provide a brief summary around the patients condition, length of condition/symptoms and any previous or current treatments/medications.
Patient's Gender**
Patient's Date of Birth

DD
MM
YYYY
Patient Notes**
How did you hear about us?**

Step 4 of 4
After this registration, the next step to access medicinal cannabis is a telehealth or in-clinic consultation with CDA Clinics. To book this consult, we will need:
- a referral letter from your GP
- a relevant health summary
- a consent form signed by you
If you don't have these forms yet, no problem - just tick the box below and we'll email you a copy of the forms to complete later. Otherwise please upload the completed documents below.
*
- I am yet to complete the forms
- I have completed the forms
Document Upload
Please tick the relevant boxes for the forms you have completed to upload them.
- Referral Letter
- Health Summary
- Consent Form
Attach Referral Letter
Max. file size: 10 MB.
Attach Health Summary
Max. file size: 10 MB.
Attach Consent Form
Max. file size: 10 MB.
Consent**
- I agree to the CDA Health and CDA Clinics Privacy Policy and Trading Terms & Conditions.
* When you click submit, a submission confirmation will appear in a new browser tab. Please check this before submitting again.

New Patient Registration

Patient Registration Form

Step 1 of 4

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Step 3 of 4

Step 4 of 4

How It works

1. Assessment

If you’re suffering from a chronic condition register with CDA Clinics today.

2. Consultation

During your telehealth or face to face consult, we'll provide a customised treatment plan and the most treatment option for your case

3. Treatment

CDA Clinics provide a range of over 150 medications, with the option to have medication securely shipped to your door.