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Edgecliff Court Suite 2
2 New McLean Street
Edgecliff NSW 2027

e: genbiome.pa@nextpracticehealth.com
w: genbiome.nextpracticehealth.com


NEW PATIENT ENQUIRY FORM


Thank you for your interest in consulting with the GenBiome team.

This enquiry form helps us better understand your health concerns, goals and practitioner preferences so we can determine the most appropriate pathway of care for you.

Once your submission has been received, our clinical team will review your information and endeavour to contact you within five business days to discuss the next steps.

If your preferred practitioner is unavailable, or we feel another practitioner may be better suited to your presentation, we will contact you to discuss the available options.

Please note that earlier appointments may occasionally become available due to cancellations or changes in practitioner availability.


Important Information

Please note the following:

- Completion of this form allows our clinical team to assess your suitability for care and, where appropriate, arrange an initial consultation with one of our practitioners.

- You will automatically be subscribed to our complimentary monthly Patient Salon Invitations and GenBiome Newsletter. You may unsubscribe at any time.

- An Onboarding Consultation with one of our Patient Advocates, Nutritionists and Health Coaches is required prior to commencing care with Dr Christabelle Yeoh, Dr Jonathan Turtle, or Dr Richard Moore.

- Dr Christabelle Yeoh currently welcomes new patients exclusively through the Next Level Care Program. Due to high demand, the anticipated wait time is currently approximately 6–8 months. Further information about the Next Level Care Program can be found here:

https://nextpracticehealth.com/locations/nsw-edgecliff/articles/next-level-care-for-dr-christabelle-yeohs-new-patients


Practitioner Locations


Dr Nicoletta (Nikki) Fisicaro

pHClinic

Shop 1, 318 Sydney Road

Balgowlah NSW 2093

Consulting Days - Wednesdays & Saturdays

Next Practice GenBiome

Suite 2, 2 New McLean Street

Edgecliff NSW 2027

Consulting Day - Fridays


Dr Kelly Francis

Neuro-Connections

Suite 3, 20 Nerang Street

Nerang QLD 4211

Consulting Days - Tuesdays (Telehealth-only) & Thursday (F2F)

Dr Francis also conducts periodic face-to-face consulting clinics at:

Next Practice GenBiome - Edgecliff

Next Practice Prahran

180 High Street

Prahran VIC 3181 (Clinic dates to be confirmed)


Dr Penny Caldicott

fugen HEALTH

Suite 3.29, 4 Ilya Avenue

Erina NSW 2250

Consulting Days - Tuesdays & Thursdays

All face-to-face consultations with Dr Caldicott are conducted from the Erina clinic.


All Other Practitioners

All remaining GenBiome practitioners consult exclusively from:

Next Practice GenBiome

Suite 2, 2 New McLean Street

Edgecliff NSW 2027


We look forward to learning more about your health journey and helping you find the practitioner and care pathway best suited to your individual needs.


New Patient's Information

Current conditions/concerns:

Past approaches/therapies that have shown improvement:

Past approaches/therapies that have not been helpful:
Areas of Interest *
Acupuncture
Brain health / neurological condition
Chinese herbal medicine
Colonic hydrotherapy / other detoxifying therapies
Digestive / gut health
Functional bodywork
Gut microbiome testing
Home Sleep Study
Hormonal health
Hypnotherapy
Integrative and Functional Chiropractic Therapies including NET (Neuro Emotional Technique), Diversified, SOT (Sacro Occipital Technique), TRT (Torque Release Technique), Vector Cranials, Intra Oral Cranials, NIT (Neurocranial Integration Technique), Dry Needling
Integrative child health
Intravenous nutrients
Lymphatic drainage
Lymphoedema therapy
Metabolic therapies such as Sauna, Hyperbaric Oxygen, Photobiomodulation, Cold Thermogenesis, Pulsed Electro Magnetic Field, Intermittent Hypoxic Training
Naturopathic consultations
Neurofeedback
Nutrigenomic and genetic testing
Nutritional coaching
Osteopathic / cranial osteopathic consultation
Other
Somatic experiencing / Somatic rebalancing acupuncture
If "Other", please provide details

Practitioner of interest: 

(for further information specific to each practitioner please visit our website: genbiome.nextpracticehealth.com)

DR MARIE PAEK: Integrative Medical Practitioner - Mental Health - Gut Health - Women's Health - Hormone Support
DR SUZI WIGGE: Integrative General Practitioner - Women's Health - Thyroid Disorders - Cardiometabolic Health
DR SARAH WONG: Integrative General Practitioner - Irritable Bowel Syndrome - Fatigue Syndromes and Mould Related Illness
DR NICOLETTA (NIKKI) FISICARO: Integrative Medical Practitioner - (consulting from GENBIOME, Suite 2/2 New McLean St, EDGECLIFF NSW 2027 on FRIDAY) - Biohacking - Longevity and Circadian Health - Metabolic Health
DR NICOLETTA (NIKKI) FISICARO: Integrative Medical Practitioner - (consulting from GenBiome's satellite location - pHCLINIC - located at Shop 1/318 Sydney Road, BALGOWLAH 2093 on WEDNESDAY and SATURDAY) - Biohacking - Longevity and Circadian Health - Metabolic Health
DR RICHARD MOORE: Integrative Medical Practitioner & Osteopath (ON-BOARDING REQUIRED) - Intravenous Nutrients - Neural Therapy - Osteopathy
DR PENNY CALDICOTT: Integrative Medical Practitioner - (consulting from fugen HEALTH, Suite 3.29/4 Ilya Ave, ERINA NSW 2250 on TUESDAY) - SPECIAL INTERESTS: Pre-pregnancy care - Pregnancy Care - Post-natal care/post-natal depletion - Thyroid Disorders - Menopause - Osteoporosis
DR SHALIKA SHETTY: Specialist Integrative Paediatrician (GP referral is required for Medicare rebate to apply) - General Paediatric Medical Concerns - Lifestyle Medicine - Behavioural and Learning Issues
DR KELLY FRANCIS: Integrative Health Practitioner - (consulting on Tuesdays and Thursdays in Nerang-QLD, ad-hoc days in Sydney and Melbourne-TBC) SPECIAL INTERESTS: PANS/PANDAS, ASD and ADHD, MCAS, and POTS
DR JONATHAN TURTLE: Integrative Medical Practitioner (ON-BOARDING REQUIRED) Chronic Fatigue - Chronic and Complex Conditions - Menopause and Hormone Issues
DR CHRISTABELLE YEOH: Integrative Medical Practitioner - (Join the waitlist for next intake - Dr Yeoh will ONLY see new patients under the NEXT LEVEL CARE program, outlined here: https://nextpracticehealth.com/locations/nsw-edgecliff/articles/next-level-care-for-dr-christabelle-yeohs-new-patients) - Gut Health - Brain health - Fatigue
Source of Referral
How did you hear about us? Who has recommended you see one of the practitioners? *
Online search
Health Professional
Family/Friend
Other
Health Hunter
HotDoc
Health Engine
Referrer Details (N/A if not applicable) *
First New Patient's Name
First Name*
Middle Name
Last Name*
Phone*
First New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
First New Patient's Signature*
Second New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Third New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Fourth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Fifth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Sixth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Seventh New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Eighth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Ninth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Tenth New Patient's Name
First Name*
Middle Name
Last Name*
New Patient's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
New Patient's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent / Guardian Information (Compulsory for Patients Under 18 Years of Age)

To ensure we can provide safe and appropriate care for your child, the following information must be completed by a parent or legal guardian. This information assists us in understanding parental responsibility, consent requirements, and family circumstances that may impact your child's care.

What is the relationship status of the child's parents/guardians?
Other (please specify)
Who is primarily responsible for managing the child's healthcare?
Are all parents/guardians involved in the child's care aware of and supportive of seeking integrative medical care?
Is there anything regarding parental arrangements, consent, or decision-making that may affect your child's care?
Yes (please provide brief details)
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Preferred Name:
Title:*
Sex at Birth:*
Preferred Pronoun:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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