City Clinic

Forms

Clinic forms and consents — available on request.

The following forms are available on request from reception:

  • Clinic Referral Form — for family physicians and primary care providers.
  • Consent to Share Information Form — authorizes sharing of clinical information with named third parties.
  • Consent for Therapy Form — for patients beginning structured psychological therapy.
  • Consent for Off-License Prescribing Form — for medications prescribed outside their licensed indication.

Contact reception by phone to request a form. Form completion is an uninsured service and attracts a fee.