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NEW PATIENT INFORMATION FORM

✔ GP-prescribed ✔ AHPRA-registered nurses

The Vitamin Guy

Client Intake Form

Please complete this form before your appointment. It usually takes 3–5 minutes. Required fields are marked with *.

1. Details 2. Safety 3. Consent 4. Submit
1. Your details
2. Medical safety check

Select anything that applies. This helps the prescribing GP and nurse assess suitability and safety.

3. Medications & allergies

Any drug allergies? *

Only required if you select “Yes”.
4. IV safety questions

Have you ever had a reaction to an IV infusion? *

Do you faint or feel unwell with needles? *

Do you have difficult veins or difficult cannulation history? *

Are you currently feverish, acutely unwell, or had an infection in the last 7 days? *

5. Reason for booking

Optional — this helps with planning, but it does not replace GP assessment.

6. Consent & declaration

Please read and tick each item before submitting.

By submitting, you agree this information will be sent to The Vitamin Guy for review and care coordination. General information only — not medical advice.