Terms and Conditions

FINANCIAL POLICY

All fees are your responsibility, even if claiming through an insurance company. Please give 24 hours notice if cancelling an appointment, otherwise a fee will be charged. We are covered by all major

Health Insurance Companies including PPP and BUPA

Signed:_________________________________________________ Date:______________________________

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CONSENT TO EXAMINATION

I consent to an appropriate physical examination.

Signed:_________________________________________________ Date:______________________________

If you are under 16 years of age, this consent should be signed by a parent or legal guardian.

Signed:___________________________________(Parent/Guardian) Date:_____________________________

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CONSENT TO TREATMENT

I have been given a Report of Findings regarding my condition. I have been advised of, and understood, the possible risks and benefits of treatment and had all my questions answered to my satisfaction. I consent to treatment as outlined to me.

Signed:_________________________________________________ Date:______________________________

If you are under 16 years of age, this consent should be signed by a parent or legal guardian.

Signed:___________________________________(Parent/Guardian) Date:_____________________________

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FEMALE PATIENTS ONLY: no. of children [ ] Is there any possibility, however small, that you may be pregnant? Y/N

Signed:_________________________________________________ Date:______________________________