New Patient Forms

Dr Taufiq Binjemain

If you would like to make an appointment to see Dr Taufiq Binjemain, please complete the below form, save the document under your full name then email it back to us at info@niimgoldcoast.com.au.  A member of our reception team will contact you within three working days to discuss booking in for an appointment.

New Patient Enquiry Form

If you have already booked in for an appointment with Dr Taufiq Binjemain, please complete one of the below forms and email back to us at info@niimgoldcoast.com.au.

New Patient Registration Form

New Patient Registration Form - Cancer patients

 

Dr Dominique Wells

To make an initial appointment with Dr Dominique Wells, please call reception on 07 5562 5333 or email to info@niimgoldcoast.com.au.  Once you have made an appointment, please complete the below form and email back to us at info@niimgoldcoast.com.au.

New Patient Registration Form - Dr Dominique Wells

 

Dr Shirley McIlvenny, Dr Tim Bajraszewski

If you would like to make an initial appointment with Dr Shirley McIlvenny or Dr Tim Bajraszewski please call reception on 07 5562 5333 or email to info@niimgoldcoast.com.au.  Once you have made an appointment, please complete the form below and email back to us at info@niimgoldcoast.com.au.

New Patient Registration Form - Dr Shirley McIlvenny, Dr Tim Bajraszewski

For all other appointment bookings or enquiries, please call reception on 07 5562 5333 or email to info@niimgoldcoast.com.au.