Australian Polyclinic · DHA Phase 5, Lahore

Patient registration

Please share your contact details and relevant health information before your first visit. This helps our clinical team prepare for your consultation.

Before you begin

  • Have your current medication list available, including doses if you know them.
  • Use “None” for a required health question if you have nothing to report.
  • Only share information relevant to your care.

Your information: The details you enter will be used by Australian Polyclinic to prepare for and coordinate your care. Before submitting, please read the clinic’s privacy notice in the form below. For questions about your information, email admin@australianpolyclinic.com. Please do not use this form for urgent medical concerns.

Registration form

Tell us about yourself

Fields marked as required must be completed. The form appears directly below this introduction.

List diagnoses with years if possible
Include dosage and frequency

Your privacy

Australian Polyclinic collects the contact and health information you provide in this form to register you and help prepare for your care. Please include only information relevant to your consultation. If you have a question about your information or need to correct it, contact admin@australianpolyclinic.com.

This form is not for urgent medical concerns. Submitting it does not book or confirm an appointment.