Patient and Procedure Information

Prior to your procedure we need you to provide us with information about yourself and the procedure that you may be seeking. You may need to come in for a pre-operative assessment. The Nurse will go through your medical history, the financial consent and the preparation instructions for your procedure. Dr. Le reviews the pre-operative assessments and thus you will get to meet him and ask him questions. Once the pre-operative assessment is completed, the procedure will be booked for you.

The following forms, questionnaires, information and instructions have been provided for your convenience. Material has been sectionalised in the procedure being sought. Please follow the link to the desired material and please take the time to read the content thoroughly.

New Patient Form

All patients who attend our centre will be asked to fill in the following form Patient Details Form.


Consent Form – Colonoscopy
Pre-operation Questionnaire – Colonoscopy
Pre-operation Instructions – Colonoscopy (3 Day Preparation)
Pre-operation Instructions – Colonoscopy (Morning)
Pre-operation Instructions – Colonoscopy (Afternoon)
Glycoprep Instructions (Morning)
Glycoprep Instructions (Afternoon)
Sigmoidoscopy Instructions
Discharge Instructions – Colonoscopy


Consent Form – Gastroscopy
Pre-operation Questionnaire – Gastroscopy
Pre-operation Instructions – Gastroscopy
Discharge Instructions – Gastroscopy

Capsule Endoscopy

Consent Form – Capsule Endoscopy
Pre-operation Questionnaire – Capsule Endoscopy
Discharge Instructions – Capsule Endoscopy

Iron Infusion

Consent Form – Iron Infusion
Pre-operation Questionnaire – Iron Infusion
Pre-operation Instructions – Iron Infusion

Cataract Surgery

Combined Patient Paperwork – Cataract Surgery
Discharge Instructions – Cataract Surgery

Fees and Charges

Information about Fees and Charges – Private Health Insurance
Information about Fees and Charges – DVA
Information about Fees and Charges – Work Cover
Information about Fees and Charges – Self Funded

Other Information

Charter of Healthcare Rights

Private Hospital Charter

Healthcare Associated Infections Consumer Factsheet

Colonoscopy Consumer Fact Sheet

Stay Safe at Home – Prevent a Fall

Further information is available from the Australian Commission on Safety and Quality in Health Care through their website:

Patient Satisfaction/Feedback/Comments/Complaints

Our centre welcomes your suggestions and comments regarding the services we have provided. Your valuable comments can help us to better assist you and others in the future.

If you would like to make any comment, complaint, or recommendation about any aspect of care you have received from our centre, please talk to our doctors or receptionists.

Alternatively, you can write to us: Ulladulla Endoscopy & Medical Centre, PO Box 110, Ulladulla, NSW 2539.

If you feel we have not handled your complaint appropriately, please contact the Health Care Complaints Commission through their website:

Reminder System

We are dedicated to looking after your health. When you are due to have repeat tests done, whether it’s a blood test or a procedure, we will telephone you or send you a reminder letter.

Management of Your Personal Health Information

Your medical record is a confidential document which is stored electronically. It is the policy of our practice to maintain the security of your personal health information at all times and to ensure that information is only available to authorised members of staff.   We abide by the Australian Privacy Principles which you can view at:

Access to Your Medical Records

If you wish to access your medical records, you can do so at any time by making an appointment to see your treating doctor. Please indicate your intention to the receptionist when making this appointment, but please note the fee for this service cannot be claimed from Medicare.