Supporting everyone to be healthy and live well

Patient Registration Form

Contact Details

Location: 226 Service Street, Echuca VIC 3564
Phone: 03 5485 5000
Fax: 03 5482 5478

Patient Registration Form

Please complete the Patient Registration eForm and include with the referral for service requested

Click here to complete Patient Registration eForm


Departments and Services Information for Health Professionals Patient Registration Form