Financial Informed Consent — Continuum Teletherapy and Allied Health

Medicare / Better Access (psychology only)

Private health insurance (check your extras cover)

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

I understand that payment is required at the time of booking or at the time of my appointment, unless I am an NDIS plan-managed patient

I understand that cancelling or rescheduling with less than 48 hours notice, or not attending without notice, will result in my booking deposit being forfeited regardless of the reason, and it will not be transferred to a future booking

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 current NDIS Support Catalogue rates

I understand that Continuum Teletherapy & Allied Health is not bulk-billing and that a gap fee applies between the service fee and any Medicare rebate

I understand that a tax invoice will be issued for each appointment and emailed to my registered email address

I understand that if I am experiencing financial hardship, I may contact admin@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?