Patient Privacy

Complete your privacy form online or download PDF form
North Coast Radiology Group has important privacy protocols in place. When attending our branches for an examination, you will be asked to complete a privacy notice form. You will also need to complete this form if you need someone to act on your behalf eg a family member or friend who needs to pick up some results or images. Once completed this form is valid for 3 years unless there are changes such as change of address.


You can complete the paper form when you arrive at a branch or online form to the right. Another option is to download the Privacy Notice Form in PDF format by clicking here


If you wish to understand our privacy policy more, please download/view it by clicking here

Patient Privacy Form

Patient Details

(firstname and lastname)
(incl area code)

Privacy Sign Off

NCRG Privacy Notice

North Coast Radiology Group (NCRG), which includes North Coast Radiology, Clarence Valley Imaging, Chatswood Radiology and Ryde Radiology, adheres to the National Privacy Principles and Health Privacy Principles in its handling of patients' personal information.

Notice about what we do
NCRG will collect your personal information from you, and sometimes where necessary from other people associated with your healthcare, in order to provide you with a health service, and for associated administrative purposes.
Your personal information, including health information, will be held, used and disclosed in accordance with the National Privacy Principles in the Privacy Act 1988 (Cth), and the Health Privacy Principles in the Health Records and Information Privacy Act 2002 (NSW). NCRG will routinely disclose your health information, including the results of any investigations, where appropriate to medical practitioners, hospitals and health care providers who are involved in your treatment or care.

You have the right to access and seek correction of the personal information and health information we hold about you. For more information, including a complete list of the ways in which NCRG uses and discloses patient information, please ask for a copy of our NCRG Patient Privacy Policy.

I authorise NCRG to collect my medical information from other health service providers, including the results of investigations performed by other medical practitioners, hospitals and health care providers, when it is necessary for NCRG to have that information to provide its services to me.

Name of person who can enquire or collect your results on your behalf. e.g. family member
This Privacy Notice will be valid for period of 3yrs