Transfer of Medical Records Enquiry

Please complete this form if you would like to transfer your medical records to Double Bay Doctors from another healthcare practitioner or clinic.

Once submitted, we will send a transfer request to the clinic you nominate. Please note that some clinics charge an administration fee for releasing records - if this applies, they may contact you directly to arrange payment before releasing your records to us.

We cannot guarantee how quickly your records will be sent, as this depends on your previous clinic. However, our team will action your request within 3 business days of receiving it.

This form is only for transferring records into Double Bay Doctors. If you need to transfer your records out of our clinic, please complete the Transfer OUT form instead.

PATIENT DETAILS

Date of Submission

First Name *

Last Name *

Date of Birth *

Contact Phone Number *

Residential Address *

Email Address Verification *

Send code

TRANSFER OF MEDICAL RECORDS REQUEST

Do you also wish to transfer records for any of your children or dependants? (Any patients aged 16 years and over must complete their own form) *

YesNo

If you answered yes, please provide us with the full name and dob for each of your dependants below

If you have already obtained a copy of your medical records from your previous practice and would like them imported into your file at Double Bay Doctors, please upload the file here

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External Medical Practitioner or Practice Name *

Medical Practice Phone Number

Medical Practice Fax Number

Medical Practice Email Address

Medical Practice Address

Signature *

Clear

Date *