Referring Doctor

Family Doctor

Physiotherapist

Next of Kin Contact

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 consultation is required at the time of consultation. Outstanding accounts may be referred to a debt collecting service.

I consent to the payment policy.

Electronically signed by

Referring Doctor 轉介醫生

Family Doctor 家庭醫生

Physiotherapist 物理治療師

Next of Kin 近親聯絡人

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。

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 consultation is required at the time of consultation. Outstanding accounts may be referred to a debt collecting service.
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)。諮詢門診費用需要當天全 額支付。未清帳款有可能會被轉教給收債服務。


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

Electronically signed by 電子簽名

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

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 consultation is required at the time of consultation. Outstanding accounts may be referred to a debt collecting service.
我理解此诊所只接受银行 转帐、Visa、 MasterCard 与银行支票 (诊所是不接受个人支票与 Amex 的)。咨询门诊费用需要当天全 额支付。未清帐款有可能会被转教给收债服务。

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

Electronically signed by 电子签名