New patient registration

To ensure that we can provide the best quality care, please complete the details below. Benson Radiology complies with the Australian Privacy Principals (APP) and this means that your personal health information is kept private and secure as required by federal and state privacy laws. Our privacy policy can be found at bensonradiology.com.au/privacy.

Branch

Call 8113 6700
Fax 8113 6799

1st Floor
57-59 Anzac Highway Ashford SA 5035

Located within the Ashford Specialist Centre on Anzac Highway (diagonally across form Hungry Jacks)

Opening Hours
Monday	7:30am - 7:30pm
Tuesday	7:30am - 7:30pm
Wednesday	7:30am - 7:30pm
Thursday	7:30am - 7:30pm
Friday	7:30am - 7:30pm
MRI available 6.40am‑8.10pm Monday to Friday
Saturday	8:30am - 12:00pm
MRI available 8:20am‑4.40pm
Sunday	8:20am - 4:40pm
MRI only

Call 8564 7000
Fax 8564 7099

13 Gawler Street Nuriootpa SA 5355

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8225 3500
Fax 8225 3599

13 Laffers Road Belair SA 5052

Parking available in the hospital car park. Entry to our department is via the ambulance entrance.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8752 9000

23 South Terrace Bordertown SA 5268

Opening Hours
Monday	Closed
Tuesday	9:30am - 1:30pm
Wednesday	Closed
Thursday	Closed
Friday	Closed
Saturday	Closed
Sunday	Closed

Call 8187 5000
Fax 8187 5099

140 Beach Road Christies Beach SA 5165

Located on the corner of Beach Road and Dyson Road

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8115 9600
Fax 8115 9699

3rd Floor
18 North Terrace Adelaide SA 5000

Free patient parking on level 3 of 18A, the multi-storey car park directly behind our building (enter off Newmarket Street). Simply take ticket at boom gate.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8193 4500
Fax 8193 4599

972 South Road Edwardstown SA 5039

Located on the right hand side of South Road, just before Castle Plaza Shopping Centre, when travelling from Anzac Highway.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8525 6200
Fax 8525 6299

46 Adelaide Road Gawler South SA 5118

Located next to McDonalds

Opening Hours
Monday	8:30am - 7:00pm
Tuesday	8:30am - 7:00pm
Wednesday	8:30am - 7:00pm
Thursday	8:30am - 7:00pm
Friday	8:30am - 7:00pm
Saturday	8:30am - 12:00pm
Sunday	Closed

Call 8177 9500
Fax 8177 9599

684 Anzac Highway Glenelg SA 5045

Located on the left hand side of Anzac Hwy (after Brighton Road) when heading west, towards the beach

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8288 5300
Fax 8288 5399

205 The Golden Way Golden Grove SA 5125

Located next to State Swim.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8350 1200
Fax 8350 1299

86 Muller Road Hampstead Gardens SA 5086

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8726 7800
Fax 8723 5100

35 Hill Avenue Keith SA 5267

Opening Hours
Monday	Closed
Tuesday	Closed
Wednesday	Closed
Thursday	9:00am - 12:30pm
Friday	Closed
Saturday	Closed
Sunday	Closed

Call 8733 0180

Millicent SA 5280

The entrance is located within the Millicent Hospital.

Opening Hours
Monday	8:45am - 4:45pm
Xray
Tuesday	Closed
Wednesday	Closed
Thursday	8:45am - 12:30pm
Xray & Ultrasound
Friday	Closed
Saturday	Closed
Sunday	Closed

Call 8397 4800
Fax 8397 4899

Modbury SA 5092

The entrance is located within the Modbury Hospital.

Opening Hours
Monday	8:00am - 5:00pm
Tuesday	8:00am - 5:00pm
Wednesday	8:00am - 5:00pm
Thursday	8:00am - 5:00pm
Friday	8:00am - 5:00pm
Saturday	8:30am - 12:00pm
Sunday	Closed

Call 8397 4700
Fax 8397 4799

Shop 25a
954 North East Road Modbury SA 5092

Entry via Smart Road.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8187 5700
Fax 8187 5799

115 Main South Road Morphett Vale SA 5162

Located on the corner of Main South Road and Flaxmill Road.

Opening Hours
Monday	7:15am - 8:15pm
Tuesday	7:15am - 8:15pm
Wednesday	7:15am - 8:15pm
Thursday	7:15am - 8:15pm
Friday	7:15am - 8:15pm
MRI only available until 8.15pm Monday to Friday
Saturday	8:15am - 4:45pm
Sunday	8:15am - 4:45pm
MRI only available until 4:45pm Saturday & Sunday

Call 8726 7300
Fax 8726 7399

Mount Gambier SA 5290

The entrance is located within the Mount Gambier and Districts Health Service.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8726 7800
Fax 8726 7899

8 Crouch Street North Mount Gambier SA 5290

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8762 0038
Fax 8762 2084

Naracoorte SA 5271

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8331 5900
Fax 8331 5999

229 Melbourne Street North Adelaide SA 5006

Onsite parking available for patients. Simply proceed beyond the automatic boom gate. Reception will provide you with a pin code to exit the car park.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 8165 6300
Fax 8165 6399

580 Lower North East Road Campbelltown SA 5074

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	8:30am - 12:00pm
Sunday	Closed

Call 8256 7100
Fax 8256 7199

256 Curtis Road Munno Para West SA 5115

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Call 7285 6000
Fax 7285 6099

39 Park Terrace Salisbury SA 5108

Located next to Aldi

Opening Hours
Monday	7:30am - 7:00pm
Tuesday	7:30am - 7:00pm
Wednesday	7:30am - 7:00pm
Thursday	7:30am - 7:00pm
Friday	7:30am - 7:00pm
Saturday	8:30am - 12:00pm
Sunday	Closed

Call 8358 7500
Fax 8358 7599

168 Cudmore Terrace Henley Beach SA 5022

Our department is located within the Western Hospital.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	8:30am - 12:00pm
Sunday	Closed

Call 8303 4600
Fax 8303 4699

486 Torrens Road Woodville North SA 5012

Located between Woodville Road and Arndale Centro Shopping Centre on the left hand side when heading towards the city.

Opening Hours
Monday	8:30am - 5:00pm
Tuesday	8:30am - 5:00pm
Wednesday	8:30am - 5:00pm
Thursday	8:30am - 5:00pm
Friday	8:30am - 5:00pm
Saturday	Closed
Sunday	Closed

Branch Email

Patient Details

Preferred title

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Mrs

Prof

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Surname

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Do you require an interpreter

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Do you have a Medicare Card?

If no, you are ineligible to claim a Medicare rebate. You may be able to claim via your travel/private insurance.

Yes

Medicare Number

Ref

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Do you have a current Pension card?

Yes

Pension number

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Do you have a Health Care card (Government concession card)?

Yes

Health Care card number (Government Concession)

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Do you have a DVA card?

Yes

DVA number

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Mobile Ph

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Occupation

My postal address is the same as listed above

Yes

Postal address

Phone

State

Postcode

Parent, legal guardian, caregiver for paediatric patient (under 18 years of age)

Title

Miss

Mrs

Other

Full name

Relationship to patient

Mobile Ph

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DOB (of parent, guardian or caregiver)

Next of Kin

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Allergies and intolerances

Do you have any allergies or intolerances?

Yes

Please list allergies or intolerances

Do you use any prescribed blood thinning medication(s)?

Yes

Please list medication(s)

Do you have a pacemaker?

Yes

Claim type (workers' compensation, MVA, insurance or legal claim)

Is your diagnostic procedure in relation to any of the above claim types?

Yes

Workers’ compensation

Yes

Motor vehicle accident

Yes

Insurance or legal claim

Yes

Do you have confirmation that your claim has been accepted by an insurer?

Yes

Research, professional development and internal training

Our team undertakes research, professional development, internal staff training and quality assurance/improvement activities to improve patient care. All those accessing personal information for this purpose have signed a written confidentiality policy.

I do not consent to my health record/personal information being used by Benson Radiology for research, professional development and internal staff training.

Financial consent declaration by patient or guardian

Benson Radiology is a private radiology practice and requires full payment of the account on the day of your appointment (unless you are an inpatient or have an approved insurance claim). Insurance claims are ultimately the patient’s responsibility. If your examination attracts a Medicare rebate, a portion of your full payment will be returned to you by Medicare. Please discuss any fees with our friendly reception team. Patients who do not attend appointments may be charged a cancellation fee.

I understand and acknowledge that it is my responsibility to pay the full amount owing for diagnostic services, examinations and procedures for today and any future appointments.

By submitting this form, I certify all information is true and correct to the best of my knowledge.

Patient or guardian full name

Date

Patient information

New patient registration