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Upper Edge Surgery
Dr Goutham Sivasuthan — Minimally Invasive and Endoscopic Surgeon
Questions? Call (07) 3333 5518

Help us prepare for your upcoming appointment

Welcome to Upper Edge Surgery
Registration Form

We're here to make your care smooth, safe and well-coordinated. Please complete the patient registration form below so our team has everything they need to look after you.

  • Specialist surgeon
  • Minimally invasive & endoscopic surgery
  • Australian-trained (FRACS)
Register onlineTakes about 5–10 minutes — no account needed.
We confirm your detailsOur team checks your referral and cover. Nothing to pay now.
Book your appointmentAlready booked? You're all set. If not, please contact our rooms to arrange a time that suits you.
Dr Goutham Sivasuthan

Your specialist

Dr Goutham Sivasuthan Australian-trained Specialist Minimally Invasive & Endoscopic Surgeon (FRACS) — the same experienced hands from first consultation through your surgical care.

Fields marked * are required.

1 · Your details

Do you need an interpreter?

2 · Emergency contact & doctor

Emergency contact

Treating doctor

Do you have a GP referral?

You can email your referral to us, or your GP can send it directly — we'll prompt you after you register.

3 · Medicare & insurance

Do you hold a valid Australian Medicare card?
Are you under 18?
Do you have private hospital health insurance?
Is this a Workcover or third-party claim?

4 · Medical history

This helps us plan your sedation and procedure safely. Everything is encrypted before storage.

Do you have diabetes?
Do you have any allergies or adverse reactions?
Do you smoke tobacco or vape?
Do you drink alcohol?
Have you, or a close blood relative, ever had a problem with an anaesthetic?
Have you been told you have sleep apnoea, or do you snore heavily?
Do you get heartburn or reflux, or food coming back up, even if you take medication for it?
Do you have any loose teeth, dentures, crowns, caps or veneers?

5 · Preferences

6 · Consent

Read the policies (cancellation · zero tolerance · health information)

Cancellation policy

Consultations. If you cancel within 48 hours of your appointment, or do not attend, a cancellation fee applies: the lower of 50% of the consultation fee or $100. Further appointments are booked once the cancellation fee has been paid. No fee applies if you are unwell or a doctor advises you not to attend (a medical certificate may be requested), or if we change or cancel your appointment. If you are a WorkCover, DVA or ADF patient, any cancellation fee must be paid by you personally and will not be covered by the third party.

Procedures. Payment for your procedure is due at least 7 days before your admission. If you cancel or move your procedure more than 7 days beforehand, your payment is refunded in full or carried to your new date. Between 7 days and 48 hours beforehand you may move to a new date once at no cost, or ask for a refund; asking for a refund instead of moving costs an administration fee of $150 on private-fee and procedure-package bookings, and never on a known-gap arrangement. If you cancel within 48 hours of your admission time, do not attend, or cannot proceed because your preparation or fasting instructions were not followed, we retain the lower of 50% of your payment or $500 as a genuine estimate of the theatre time that cannot be reallocated at short notice, and refund the balance; we may at our discretion apply the retained amount to a new date. This does not apply if you are unwell or a doctor advises you not to proceed (a medical certificate may be requested), or if the practice, the hospital or the anaesthetist cancels; in those cases you receive a full refund or a free new date. A prepayment cannot be claimed from Medicare or your health fund until your procedure has taken place.

Zero Tolerance Policy

Upper Edge Surgery has a zero-tolerance approach to any verbal, aggressive or violent abuse and behaviour towards our doctors, staff or other patients. Abusive behaviour — including offensive language, yelling, verbal insults, physical violence, racial abuse or sexual harassment — will result in the person being required to leave the practice, and may mean care is transferred elsewhere; in extreme cases the police will be called. We have the right to refuse treatment to anyone who threatens the safety of our staff or patients.

Health information release

I give my consent to Dr Goutham Sivasuthan of Upper Edge Surgery to contact medical practitioners or other bodies I have consulted to obtain health and other information that may be pertinent to my care, and I authorise those practitioners or bodies to release such information (which may include sensitive health information) to Dr Sivasuthan and the practice. I authorise Dr Sivasuthan to include the medical practitioners I have named in patient correspondence (reports, letters or other means) as applicable to my care.

Your registration goes securely to our team. If you haven't booked an appointment yet, please contact our rooms.

Unable to complete this form online?

Online registration is the fastest way for your details to reach our team. If you genuinely cannot complete it online, our practice staff can give you a printable version to fill in by hand.