New Patient Registration

/ New Patient Registration

Patient Registration Form

Begin your journey by completing the patient registration form below. Once registered, you’ll receive an 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.

If you have already submitted your details to us, please do not re-register again.

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Registration Type**
Patient's First Name**
Patient's Surname**

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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*

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What is your primary condition diagnosis?**
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Other primary condition**
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How long has the condition lasted?**
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What are your primary symptom/s?**
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Other primary symptoms**
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Do you have any previous experience or knowledge of Medicinal Cannabis?**
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Which cannabinoids are you interested in discussing with our doctors?**
Extra Notes (Not Required)
How did you hear about us?**

New Patient Registration

Patient Registration Form

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How It works

REGISTER

Register with CDA Clinics as a patient via the patient registration page and receive an information pack.

CONSULT

Once we receive a Referral and Health Summary from your regular doctor and a CDA Consent Form (signed by you), you can book in your consultation.

RECEIVE

If approved via one of the TGA Special Access Schemes, the doctor will write a prescription for the appropriate medication.