Please complete the following details.
If you require assistance, please ask our friendly staff.
MISSED APPOINTMENTS AND PAYMENT OF FEES
We understand that in certain circumstances you might not be able to keep an appointment, however, it is expected that 24 hours notice is given if you are not going to attend your appointment. Failure to do this will incur a $50.00 fee, which is not refundable through Medicare and payable before booking the next appointment.
***Also, being more than 10 minutes late for an appointment may require re-booking***
**Payment of fees for services provided are to be paid at the time of consultation. **
I have read the above information and give my consent to Foot Ankle & Rehabilitation Clinic to use my details when communicating with other parties involved in my care.
I am aware of the clinics policy regarding missed and late appointments.
I agree to pay all fees relating to services provided at the time of my appointment.
I agree as Parent/Guardian of a minor to pay all fees relating to services provided at the time of the appointment.