Urology - outpatient pre-clinic questionnaire
This questionnaire has been designed to save you time at your clinic appointment. Please fill in as much as possible prior to coming to hospital.
Remember to bring along previous scans, results and letters from previous hospital visits (public or private) that are relevant to your appointment.
Collection notice
Queensland Health (QH) is required to manage your personal information in accordance with the Information Privacy Act 2009 and the Hospital and Health Boards Act 2011, Part 7 Confidentiality. QH is collecting the personal information on this form to assist in chart preparation for your pregnancy booking in visit and to assess your individual pregnancy health care needs. This form will be printed and filed in your patient medical record. Some of your personal information on your medical record may be given to carers, guardians or other government departments who provide associated services that require your information for the purpose of providing a health care service. Your information will be disclosed without your consent, if authorised or required by law. For further information about privacy and your health record please ask for a copy of the Queensland Health Privacy Brochure or visit www.health.qld.gov.au.
Contact us
Urology Outpatient Clinic
Location: Level 8, Ned Hanlon Building
Phone: (07) 3646 6810
Fax: (07) 3646 1711
Email: RBWH-confirmationcentre
Open: Monday-Friday 8.00am-4.30pm
Need help outside hours?
For non-urgent medical issues call 13 HEALTH (13 43 25 84) or visit your GP.
In an emergency call 000.
Refer a patient
To refer a patient to this service, view the Urology referral guideline.
GP and Specialist Referral Hotline:
1300 364 938