Simply click on your selected form name below and it will open in a new window for you to download or print.

  • New Patient Form
    Are you a new patient? Please fill out this New Patient Form and bring it to your appointment at Blackbutt Doctors Surgery.
  • Practice Information Sheet
    If you are a new patient with us please download this practice information sheet to find details on our services and procedures, fees, appointments and other important information about Blackbutt Doctors Surgery.
  • DASS form
    If you are coming to talk to your GP about depression or anxiety please fill out the DASS form before attending your appointment. This is a standardised questionnaire to help your GP understand your current condition and how he or she can help.
  • CASA Form Description
    If you have booked an appointment to do your Aviation Medical please download the CASA Form and complete as much as you are able to, bring it with you to your appointment and your GP will assist in completing the form.
  • Referral for Iron Infusion Clinic Form
    o   If you attend another practice and your GP has requested an appointment with Dr Rochelle for your iron infusion please make sure your GP has completed and provided you with a copy of this iron infusion referral form.
  • IUD Form
    If you are thinking about an IUD contraceptive please read this information fact sheet and discuss this option with your doctor at your next appointment.

Developmental Checklists

These checklists are for parents with young children. Complete the developmental checklist prior to seeing a doctor and/or nurse to make your appointment more efficient and ensure that any concerns can be found and raised with the doctor in your appointment.

Simply click on your selected form name below and it will open in a new window for you to download or print.

12 months and under

18 months – 4 years

5 years and over