Consent & Practice Terms

I, the patient named above, do hereby consent to the release of any medical information to other health professionals (i.e. specialists, GP’s and other health entities including hospital) as deemed necessary by Dr Kumar, whereby the release of such information is to further my health management.

I also consent to information being obtained by Dr Kumar from other health professionals (i.e. specialists, GP’s and other entities including hospital) for the continued treatment of my medical condition.

I agree with the following:

• I understand results cannot be printed and am happy for them to be emailed.
• I understand that I am fully responsible and liable if I or my accompanying parties cause damage to the premises or another vehicle whilst attending my appointment.
• I understand I am fully responsible for providing a current referral and agree that my appointment may have to be postponed if I don’t have one for the appointment scheduled.
• I understand that my Doctor may run behind scheduled appointment times and will allow enough time for that occurrence.
• I understand fees are non-refundable.
• I will not display any violent, aggressive or rude behaviour.
• I accept that payment is made at the time of the appointment.
• I understand the practice does not accept cheques or bulk bill any appointments.
• I understand if I require my scripts/dosage amended or change outside of a routine consultation, I agree that I may need to pay for the cost of any changes.
• I understand these appointments are private and confidential and will not enquire about another person’s information or details.
• I understand that the patient consultation letters are for communication between physicians and contain complex medical information and terminology. They are not for my education as it may be misunderstood or misinterpreted. I understand that I may need to receive additional information to ensure I comprehend the content and context if the letter is released.
• I agree that I will not release any documents or letter that I obtain from the practice without the express permission from the Doctor.
• I understand that any manipulation of any letters without the permission of the Doctor for any purpose will void the Doctor/patient relationship, resulting in termination of care.
• I understand that if I have any queries that require the Doctor to call and discuss this will automatically be classified as a telephone consultation and may incur costs, which I agree to pay for.
• I agree to the use of AI software in the construction of letters sent to my GP and other specialists. I understand deidentified, encrypted AI is used for the summary of my consultation appointment with my Doctor. If you have any questions on AI use, please reach out to us.