New Patient Form

    Patient Details

    Contact details

    Next of Kin

    Referring Doctor

    Healthcare Details

    Private Health Fund Details

    For DVA Card Holders please complete the details below:

    For Workers Compensation / Third Party / Public Liability please complete the details below:

    Medical Questionnaire

    Medical Conditions

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    I am seeing Dr Yu for my: *

    Select the main issue for this consultation

    Which arm is affected?

    Have you ever had any complications after surgery?

    How did you hear about us?

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    COVID-19 Safety

    Accounts Policy

    The consultation and surgical fees charged by Dr Yu are based on the AMA Schedule of Fees, and are as follows: Initial Consult: $180 (Aged Pension $150). Review or Follow-up Consult: $100 (Aged Pension $80).

    Please note that whilst we are conducting Telehealth to reduce the spread of COVID19 – there will be no out of pocket expenses for these consults.


    It is a term of the provision of these services that the patient shall be liable for all debt collection fees and charges, including but not limited to agent fees, solicitor costs and disbursements in the event that the collection is required. Please note that Medicare does not completely cover the cost of your consultation. I agree to take full responsibility for the prompt payment of all my accounts.

    I consent to the release and communication of information from and to any other medical provider, for the purpose of my ongoing clinical management and for ongoing clinical research, audit and education (Letters, Images and Video). Clinical images may be used in a de-identified manner for marketing or education purposes.

    Yes, I agree with the privacy policy and terms and conditions.

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