Partner Clinic Registration

Thank you for choosing to register with Medmate.
Upon acceptance, your clinic will be enabled for electronic referrals. The medical clinic agrees to:
1. Installation of the e-referral software.
2. Informing patients about the electronic referral service.
3. Distributing the "E-Referral Guide for Practitioners" and requiring referring doctors to gain the consent of patients to participate in the e-referral service.
4. Patients receiving a referral directly by email or SMS.
5. Participating pathology and radiology providers accessing referral information for the purposes of statistical usage reporting and undertaking clinical investigations ordered by the referring doctor.
Medmate is free of charge for medical clinics.

Clinic Details

Clinic Trading Name*

Registered Business Name*

Australian Business Number (ABN)*

Website*

Address*

Street Address Address Line 2 City State / Province / Region Postcode

Clinic Phone Number*

Clinic Email Address

Email address to receive notifications

Software

Practice Management Software

Other Software

Software Version Number If Known

Practice Manager

*

First Last

Practice Manager Email*

Practice Manager Mobile Number

Online booking provider

Providers

Preferred pathology provider

Preferred radiology provider

Consent

Name of Practice Manager

I agree to the Medmate Terms and Conditions and Privacy Policy.

Medical Clinic e-Referral Registration

Clinic Details

Software

Practice Manager

Providers

Consent