STEP 1 of 6
If you need help with completing this registration call the Spleen Australia on 03 9076 3828 or if you are a Queenslander - call 1800 SPLEEN (775336)


  1. 1. The process takes approximately 5 minutes
  2. 2. You will need vaccination dates (if possible)
  3. 3. You can only enter YOUR INFORMATION once
  4. 4. If you leave your computer for more than 15 minutes – you may lose the information you have entered
  5. 5. Confirmation of registration will occur after completing final page

To close, press the ESC key or click outside this box.

I am providing information about:  

Please complete the personal details of the patient below. When complete click the next button. If you need to go back a page click the previous button. Press TAB to move from box to box.
Personal Details of Patient
First Name
Middle Name
Family Name
Date of Birth   dd/mm/yyyy
Medicare Number
Address 1
Address 2
Please provide at least 2 of the contact details below.
Home Phone example: (03) 9999 8888
Mobile example: 0400 999 888
Email Address
Do you have an iPhone/iPad (for Spleen App)?  
Are you [is the person] of Aboriginal or Torres Strait Islander origin?