Queensland Tongue Tie Clinic Online Registration Forms

In order to confirm your appointment we do require a complete medical history on the person having a procedure with Queensland Tongue Tie Clinic. All information provided is confidential and will be handled in accordance with our Privacy Policy.
By completing the online form you are making an informed consent to the procedure being carried out. For a child aged 00 – 14 years you are making an informed consent for the procedure to be performed on your child, and that you are the legal parent / guardian.
If you do not consent to any of the above or wish to discuss further with your treating doctor, do not complete the form and contact our office.

Child Registration Form

Register Here

Adult Registration Form

Register Here

Non Attending Parental Consent

Register Here

Get in touch to make an appointment

Phone: 07 2103 2322

Email: info@queenslandtonguetieclinic.com.au