Thank you for choosing to register with Adelaide Medical Centre. To ensure your child's registration can be fully completed and that their medical record is kept up-to-date, please complete this form as accurately as possible. Do ensure that you have your child's immunisation history available when completing the form.
Last Updated: 19/05/2022
Child's Personal Details
Parent / Guardian (s) Details
Next of Kin
Please note that Proxy Online Access, to some aspects of the child's medical record can be requested for children under the age of 12. Further information and application can be found on our website.
Child's Medical History
Child's Immunisation History
It is important that we have an up-to-date record of your child's vaccinations to ensure your child is fully immunised in accordance with the UK Immunisation Schedule
Immunisations of Children Aged 12 -15 Years old
Please move to the next section if not applicable
Family Medical History
Additional General Details