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​CONSENT TO RELEASE MEDICAL INFORMATION

If you wish to have consultation notes or results sent to your GP or another specialist, please download and complete our Patient Authority to Release Medical Information to a Nominated Party form via the link below.

Please ensure you scan and email the completed form to:

​

reception@leake.com.au for Drs Leake and Fitzgerald

reception@drjenniferpontre.com.au for Dr Pontré

reception@karthigasu.com.au for Dr Karthigasu

info@drpipparobertson.com.au for Dr Robertson

reception@julania.com.au for Dr Julania

 

or

b) Bring the completed hard copy form to your initial appointment.

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Dr Robyn Leake

(08) 9389 5065

Hollywood Medical Centre
Suite 33, 85 Monash Avenue
Nedlands, WA, 6008

Dr Krish Karthigasu

Hollywood Medical Centre
Suite 32, 85 Monash Avenue
Nedlands, WA, 6008

Dr Jennifer Pontré

Hollywood Medical Centre
Suite 33, 85 Monash Avenue
Nedlands, WA, 6008

Dr Phillipa Robertson

Hollywood Medical Centre Suite 32, 85 Monash Ave

Nedlands WA 6008 

© 2022 Hollywood Gynaecology 

Dr Amy Fitzgerald

Hollywood Medical Centre Suite 33, 85 Monash Ave Nedlands WA 6008

Dr Shital Julania

Hollywood Medical Centre Suite 32, 85 Monash Ave Nedlands WA 6008 

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