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About
Dr Darren Paterson
Northshore Bone & Joint
Hip
Hip Conditions
Hip Arthritis
Avascular Necrosis (Hip)
Femoral Acetabular Impingement (FAI)
The Painful or Failing Hip Replacement
Hip Surgery
Total Hip Replacement (Arthroplasty)
Revision Hip Replacement (Arthroplasty)
Hip Arthroscopy
Hip Resurfacing
Knee
Knee Conditions
Knee Arthritis
Meniscal Tears
ACL Tears
Knee Instability
The Painful Or Failing Knee Replacement
Knee Surgery
Radio Frequency Ablation (Knee)
Knee Arthroscopy
Anterior Cruciate Ligament (ACL) Reconstruction
Partial Knee Replacement (Arthroplasty)
Total Knee Replacement (Arthroplasty)
Patient Specific (PSI), Kinematically Aligned, Total Knee Replacement
Robotic-Assisted Total Knee Replacement
Revision Knee Replacement Surgery
Patient Hub
Your Appointment
Cortisone Injections
Hyaluronic Acid Injections
Before Your Surgery
Anaesthesia For Surgery
Your Surgery Post-Op
Fees & Billing Info.
New Patient Form
News
Contact
Contact Us
Consulting Locations
Operating Hospitals
Home
About
Dr Darren Paterson
Northshore Bone & Joint
Hip
Hip Conditions
Hip Arthritis
Avascular Necrosis (Hip)
Femoral Acetabular Impingement (FAI)
The Painful or Failing Hip Replacement
Hip Surgery
Total Hip Replacement (Arthroplasty)
Revision Hip Replacement (Arthroplasty)
Hip Arthroscopy
Hip Resurfacing
Knee
Knee Conditions
Knee Arthritis
Meniscal Tears
ACL Tears
Knee Instability
The Painful Or Failing Knee Replacement
Knee Surgery
Radio Frequency Ablation (Knee)
Knee Arthroscopy
Anterior Cruciate Ligament (ACL) Reconstruction
Partial Knee Replacement (Arthroplasty)
Total Knee Replacement (Arthroplasty)
Patient Specific (PSI), Kinematically Aligned, Total Knee Replacement
Robotic-Assisted Total Knee Replacement
Revision Knee Replacement Surgery
Patient Hub
Your Appointment
Cortisone Injections
Hyaluronic Acid Injections
Before Your Surgery
Anaesthesia For Surgery
Your Surgery Post-Op
Fees & Billing Info.
New Patient Form
News
Contact
Contact Us
Consulting Locations
Operating Hospitals
MAKE BOOKING
Home
About
Dr Darren Paterson
Northshore Bone & Joint
Hip
Hip Conditions
Hip Arthritis
Avascular Necrosis (Hip)
Femoral Acetabular Impingement (FAI)
The Painful or Failing Hip Replacement
Hip Surgery
Total Hip Replacement (Arthroplasty)
Revision Hip Replacement (Arthroplasty)
Hip Arthroscopy
Hip Resurfacing
Knee
Knee Conditions
Knee Arthritis
Meniscal Tears
ACL Tears
Knee Instability
The Painful Or Failing Knee Replacement
Knee Surgery
Radio Frequency Ablation (Knee)
Knee Arthroscopy
Anterior Cruciate Ligament (ACL) Reconstruction
Partial Knee Replacement (Arthroplasty)
Total Knee Replacement (Arthroplasty)
Patient Specific (PSI), Kinematically Aligned, Total Knee Replacement
Robotic-Assisted Total Knee Replacement
Revision Knee Replacement Surgery
Patient Hub
Your Appointment
Cortisone Injections
Hyaluronic Acid Injections
Before Your Surgery
Anaesthesia For Surgery
Your Surgery Post-Op
Fees & Billing Info.
New Patient Form
News
Contact
Contact Us
Consulting Locations
Operating Hospitals
Home
About
Dr Darren Paterson
Northshore Bone & Joint
Hip
Hip Conditions
Hip Arthritis
Avascular Necrosis (Hip)
Femoral Acetabular Impingement (FAI)
The Painful or Failing Hip Replacement
Hip Surgery
Total Hip Replacement (Arthroplasty)
Revision Hip Replacement (Arthroplasty)
Hip Arthroscopy
Hip Resurfacing
Knee
Knee Conditions
Knee Arthritis
Meniscal Tears
ACL Tears
Knee Instability
The Painful Or Failing Knee Replacement
Knee Surgery
Radio Frequency Ablation (Knee)
Knee Arthroscopy
Anterior Cruciate Ligament (ACL) Reconstruction
Partial Knee Replacement (Arthroplasty)
Total Knee Replacement (Arthroplasty)
Patient Specific (PSI), Kinematically Aligned, Total Knee Replacement
Robotic-Assisted Total Knee Replacement
Revision Knee Replacement Surgery
Patient Hub
Your Appointment
Cortisone Injections
Hyaluronic Acid Injections
Before Your Surgery
Anaesthesia For Surgery
Your Surgery Post-Op
Fees & Billing Info.
New Patient Form
News
Contact
Contact Us
Consulting Locations
Operating Hospitals
New Patient Form
Title
Given Names (Dr / Mr / Mrs / Ms / Miss / Mast)
Surname
Date of Birth
Occupation
Telephone – Home
Mobile
Email Address
Age
Address
City
State
Postcode
Next of Kin
Relationship
Mobile
Medicare number
Individual Reference Number
Expiry Date
Private Health
Fund name
Member no.
DVA
Referring doctor
Practice address
City
State
Postcode
If the referring doctor is not your General Practitioner, please provide their details.
GP name
Practice name
Practice address
City
State
Postcode
Do you currently have a regular physiotherapist you see?
Physiotherapist name
Practice address
City
State
Postcode
In your own words what is the problem that you are seeing Dr Paterson about, how is it affecting your daily life, how long have you had this problem and, is it getting better or worse?
Have you had any previous operations? If so, what and were there any problems or complications?
Does this cover you for treatment in a private hospital?
Yes
No
Have you had cover for more than 12 months?
Yes
No
Medical History
Do you take regular medications?
Yes
No
If yes, do you regularly take:
Warfarin
Clopidogrel
Aspirin
Other blood thinners
Do you regularly take herbal medications?
Yes
No
If yes, which ones?
Do you regularly take pain medications?
Yes
No
If yes, please specify type, quantity and frequency.
Do you drink alcohol?
Yes
No
If yes, how many days per week?
How many drinks per day?
Do you smoke cigarettes?
Yes
No
If yes, how many cigarettes per day?
How many years have you been smoking for?
Are you allergic to the following?
Latex
Iodine
Chlorhexidine
Dressings
Please specify which ones.
Do you have drug allergies?
If yes, please specify which ones and what the allergy is.
Rash
Shortnessof breath
Swelling
Anaphylaxis
Other
Have you had any type of previous surgery?
Yes
No
If yes, please list the type of surgery and when.
If you are male, over 50 do you need to get up at night often to urinate?
Medical Checklist
Please check the boxes that apply below OR check this box if you do not have any medical problems:
Cardiac
Heart attack
High blood pressure
Low blood pressure
INFECTIONS
Hepatitis B
Hepatitis C
HIV/AIDS
RESPIRATORY
Pulmonary embolus
Asthma
Emphysema (COPD)
Obstructive Sleep apnoea (CPAP)
DVT
CANCER
Breast
Lung
Prostate
Knee region
Other
Other
ENDOCRINE
Diabetic
Diet Tablets
INSULIN
Overactive thyroid
Underactive thyroid
OTHER
Rheumatoid arthritis
Inflammatory arthritis
Kidney problems
Strokes
Indigestion or reflux
Stomach ulcers
OTHER
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