Patient Questionnaire – New Patients

You accept that Auckland Eye may access your external health records (e.g. from public hospital and GP) to provide appropriate care for you.

You confirm that the above details are correct and accept that Auckland Eye will provide a copy of your clinical results and details of your consultation(s) to your General Practitioner / Optometrist / Specialist and / or other referrer.

Auckland Eye may use the above details including email to advise of appointments, send correspondence and patient satisfaction surveys.

You consent to us using your personal information to confirm your identity, appointment and verifying information is correct , both directly and indirectly at peripheral locations.

From time to time, we work with other trusted affiliate healthcare practices and share patient diagnostic testing equipment when providing patient care. They may access your patient information through this equipment when providing this care. We have strict policies and non-disclosure agreements to prevent unauthorised access to and misuse of patient information.

Auckland Eye does not have a language interpreting service on site; if required please inform our reception staff who can assist you by providing details of available services.

You accept that you are responsible for payment of all services received at Auckland Eye and payment is required on the day. We do not guarantee your insurer will fund your consultation fees, tests or procedures so you will be responsible for any costs or co-payments related to these. Please note that fees are subject to change without notification. Failure to attend the appointment or cancel within 24 hours of the appointment may incur a fee.

Southern Cross Insurance (SX) Members: By signing this form, you authorise Auckland Eye to obtain prior approval, share information with SX and process your claim as an affiliated provider. Please note it is the members responsibility to check benefits, which can be done through MySouthernCross App, website or calling SX.

Please note: Some of our doctors use secure note-taking tools to capture the details of your consultation accurately and efficiently. These tools transcribe conversations in real time, and no recordings are stored. All tools we use comply with the Privacy Act 2020 and the New Zealand Information Privacy Principles.