Patient Intake Online Form

 By consenting above, you enable this practice to collect relevant and store relevant information about you and your health, and any relevant information of your endocrine health. Your consent allows Dr Yoges Venugopal and other staff vital information about your health for effective diagnosis and treatment. From time to time, we may need to obtain or share information with other health providers who may have treated you or may treat you in the future, such as emergency departments, other specialists or your General Practitioner.

 I give my consent to the collection of information and release to third parties

 for these purposes.