Patient Consent and Declaration:
By signing below:
(1) I understand and give permission to this medical practice to collect, store, use and communicate my personal details and medical history to other medical professionals, allied health services and insurers. The information provided may be used for administrative and billing purposes (including Medicare, private health insurance, workers’ compensation insurance and CTP insurance), and to provide medical care and other health services to me. This information may be communicated electronically. My information may be used for medical research, teaching and audit purposes (all information will be de-identified prior to such use);
and (2) I understand that it is my responsibility to pay all fees associated with my care at the time or prior to consultation or surgery. Debt collection services may be utilised at my cost for outstanding fees. In case of workers’ compensation or CTP claims where the claim is declined, it is my responsibility to pay the fees involved with my care personally.
