Patient Agreement

Patient Name:

I ,
confirm that I have read the patient information and practice policy handout or website information

I agree to take responsibility for my own health and be an active partner in my own healthcare

I agree to attend all appointments, treatment schedules and consultations as requested by my physician

I understand and agree to the policies of this practice, specifically:

I understand that I will be asked to complete online patient forms before every visit.
I am aware that there are fees associated with some uninsured services and I am responsible for paying these (e.g. sick note, disability forms, insurance forms and medical reports)
I understand that it is NEVER acceptable to verbally or physically abuse any clinic staff and that such behaviour will lead to immediate termination of the physician-patient relationship.
I understand and agree to the principles of this practice. If I am unable to follow these principles, I am aware I may be discharged from the practice.



Send Fax