Financial Informed Consent, Continuum Teletherapy and Allied Health

Private health insurance (check your extras cover)

How are you funding this service?

I have been informed of the fees for my service and understand what I will be charged for each appointment

I understand how payment works for my funding arrangement as set out above, and when I will and will not be charged

I understand that no deposit is payable, that my card is securely stored at the time of booking and charged shortly after my consultation begins, and that a cancellation or non attendance with less than 48 hours notice will result in a fee of 50 per cent of my consultation fee being charged to the card on file

I understand that if I am an NDIS-funded patient, I must sign a NDIS Service Agreement before services commence and that fees are charged at the current NDIS Pricing Arrangements and Price Limits rates

I understand that Continuum does not bulk bill, that a Medicare rebate requires a valid GP referral and care plan for the service I am receiving, that I pay the consultation fee and claim the rebate myself, and that I am responsible for the gap between the fee and the rebate

I understand that no deposit is payable, that if I am self managed my card is securely stored at booking and my consultation fee is charged shortly after my consultation begins so that I can then claim reimbursement from the NDIA, that if I am plan managed my plan manager is invoiced directly and no card is stored, and that a short notice cancellation or non attendance may be claimed from my NDIS plan in line with the current NDIS Pricing Arrangements rather than charged to me personally

I understand that no deposit is payable, that my supports are claimed directly from the NDIA and no card is stored, that I am not charged anything personally, and that a short notice cancellation or non attendance may be claimed from my NDIS plan in line with the current NDIS Pricing Arrangements and Price Limits rather than charged to me

I understand that DVA is billed directly for my psychology care, that I am not charged any fee at any time including for cancellation or non attendance, that I must have a valid GP referral before my first consultation, and that dietetics cannot be provided through DVA because it cannot be delivered by video

I understand that my insurer is billed directly at the SIRA scheduled rate, that I am not charged any fee at any time including for cancellation or non attendance, and that I must provide a valid claim number before my first consultation

I understand that a tax invoice is issued for every consultation, and that depending on how my care is funded it is emailed either to me or to the organisation paying for my care

I understand that if I am experiencing financial hardship, I may contact reception@continuumteletherapy.com.au to discuss my situation before my appointment

Financial Informed Consent, Continuum Teletherapy and Allied Health

Your Details

Full legal name

Date of birth

Email address

How are you funding this service?