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Pre-Surgery術前須知术前须知
Post-Surgery術後須知术后须知
Rehab Protocols康復常規康复常规
Shoulder Surgery肩部手術肩部手术
Elbow Surgery肘部手術肘部手术
Knee Surgery膝部手術膝部手术
Ankle Surgery踝部手術踝部手术
New Patient初診資訊初诊资讯
Contact聯絡方式联络方式

Patient Registration Form - WorkCover / TAC

Under 18 years of age

Referring Doctor

Family Doctor

Physiotherapist

Next of Kin Contact

WorkCover

TAC

Appointment Reminder, Messages & Emails

Please advise the front desk staff if you do not wish to receive SMS reminders, or any other message or emails.

I consent to receive SMS reminders, messages and emails.

Privacy Policy

I understand that this practice handles personal information in accordance with the National Privacy Principles enshrined in the Privacy Act 1988 (Commonwealth) and as outlined in the Privacy Statement.

I consent to the handling of my information by this practice for the purpose of providing quality health care, administrative billing purposes and communication with other treating allied health professionals e.g. physiotherapist

I also give permission for medical information to be obtained from any other source in order to help with my treatment.

Payment Policy

I understand that this practice accepts bank transfer, Visa, MasterCard, and bank cheque only (personal cheque and Amex are NOT accepted). Full payment for the initial consultation is required at the time of consultation. WorkCover and TAC patients are responsible for paying the full private fee of the first consultation, and will be provided with an invoice to reimburse the cost of consultation back from their employer, WorkCover insurer or TAC. In some situations, there may be a small gap between our fees and the amount refunded by the employer, WorkCover insurer and TAC.

The fee of subsequent appointment(s) after the initial consultation will be billed directly to the employer, WorkCover insurer or TAC, provided the claim has been formalised and our practice has been provided with those details.

I consent to the payment policy.

Electronically signed by

看診者個人資料表 - 職場傷害/交通傷害

Patient Registration Form - WorkCover / TAC

UNDER 18 YEARS OF AGE 是18歲以下

Referring Doctor 轉介醫生

Family Doctor 家庭醫生

Physiotherapist 物理治療師

Next of Kin Contact 近親聯絡人

WorkCover 職場傷害

TAC 交通傷害

門診預約提醒、留言&電子郵件

Please advise the front desk staff if you do not wish to receive SMS reminders, or any other message or emails.
如果您不希望收到短信提醒或任何其他留言或電子郵件,請通知前台工作人員。

I consent to receive SMS reminders, messages and emails.
我同意收到短信提醒、留言或電子郵件。

隱私條約

I understand that this practice handles personal information in accordance with the National Privacy Principles enshrined in the Privacy Act 1988 (Commonwealth) and as outlined in the Privacy Statement.
年的隱私法(Commonwealth)所規定的國家隱私法則與診所隱私聲明原則來處理私人資訊。

I consent to the handling of my information by this practice for the purpose of providing quality health care, administrative billing purposes and communication with other treating allied health professionals e.g. physiotherapist.
我同意此診所為了以提供優質的醫療保健、費用文書管理和與其他合作治療的專業醫療人士溝通之目的來處理我的資訊,例如物理治療師等。

I also give permission for medical information to be obtained from any other source in order to help with my treatment.
我同時也允許此診所為了協助我的治療之目的,而從其他出處取得我的醫療紀錄。

Electronically signed by 付款條約

I understand that this practice accepts bank transfer, Visa, MasterCard, and bank cheque only (personal cheque and Amex are NOT accepted). Full payment for the initial consultation is required at the time of consultation. WorkCover and TAC patients are responsible for paying the full private fee of the first consultation, and will be provided with an invoice to reimburse the cost of consultation back from their employer, WorkCover insurer or TAC. In some situations, there may be a small gap between our fees and the amount refunded by the employer, WorkCover insurer and TAC.

The fee of subsequent appointment(s) after the initial consultation will be billed directly to the employer, WorkCover insurer or TAC, provided the claim has been formalised and our practice has been provided with those details.
我理解此診所只接受銀行轉帳、Visa 、 MasterCard 與銀行支票 (診所是不接受個人支票與 Amex 的)。初診諮詢門診費用需要當天全額支付。職場 傷害或交通傷害的病患需要負責支付全額的初診私人費用,診所會提供收據發票。看診者可以依據發票向雇 主、公司保險或交通事故委員會申請初診費用補償。我們的費用與退款金額在某些情況下也許會有微小差額。 初診之後的看診費用則會直接向雇主、公司保險或交通事故委員會開帳單申請,其前提是案件號碼已經正式 確認下來,同時案件資訊也提供給到診所。


I consent to the payment policy.
我同意付款條約 。

電子簽名

看诊者个人资料表 - 职场伤害/交通伤害

Patient Registration Form - WorkCover / TAC

Under 18 years of age 是18岁以下

Referring Doctor 转介医生

Family Doctor 家庭医生

Physiotherapist 物理治疗师

Next of Kin 近亲联络人

WorkCover 职场伤害

TAC 交通伤害

门诊预约提醒、留言&电子邮件

Please advise the front desk staff if you do not wish to receive SMS reminders, or any other message or emails.
如果您不希望收到短信提醒或任何其他留言或电子邮件,请通知前台工作人员。



I consent to receive SMS reminders, messages and emails.
我同意收到短信提醒、留言或电子邮件。

隱私條約

I understand that this practice handles personal information in accordance with the National Privacy Principles enshrined in the Privacy Act 1988 (Commonwealth) and as outlined in the Privacy Statement.
我理解此诊所是根据 1988年的隐私法(Commonwealth)所规定的国家隐私法则与诊所隐私声明原则来处理私人资讯。

I consent to the handling of my information by this practice for the purpose of providing quality health care, administrative billing purposes and communication with other treating allied health professionals e.g. physiotherapist.
我同意此诊所为了以提供优质的医疗保健、费用文书管理和与其他合作治疗的专业医疗人士沟通之目的来处理我的资讯,例如物理治疗师等。

I also give permission for medical information to be obtained from any other source in order to help with my treatment.
我同时也允许此诊所为了协助我的治疗之目的,而从其他出处取得我的医疗纪录。

付款條約

I understand that this practice accepts bank transfer, Visa, MasterCard, and bank cheque only (personal cheque and Amex are NOT accepted). Full payment for the initial consultation is required at the time of consultation. WorkCover and TAC patients are responsible for paying the full private fee of the first consultation, and will be provided with an invoice to reimburse the cost of consultation back from their employer, WorkCover insurer or TAC. In some situations, there may be a small gap between our fees and the amount refunded by the employer, WorkCover insurer and TAC.

The fee of subsequent appointment(s) after the initial consultation will be billed directly to the employer, WorkCover insurer or TAC, provided the claim has been formalised and our practice has been provided with those details.
我理解此诊所只接受银行转帐、Visa、 MasterCard 与银行支票 (診所是不接受个人支票与 Amex 的)。诊咨询门诊费用需要当天全额支付。职场伤害或 交通伤害的病患需要负责支付全额的初诊私人费用,诊所会提供收据发票。看诊者可以依据发票向雇主、公 司保险或交通事故委员会申请初诊费用补偿。我们的费用与退款金额在某些情况下也许会有微小差额。初诊 之后的看诊费用则会直接向雇主、公司保险或交通事故委员会开帐单申请,其前提是案件号码已经正式确认 下来,同时案件资讯也提供给到诊所。

I consent to the payment policy.
我同意付款条约 。

Electronically signed by 电子签名

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