Cottage Surgery Terms & Conditions
Appointments and Fees
I understand there may be additional charges incurred beyond the standard consultation fee if any additional tests and/or procedures are required.
I understand my doctor requires payment on the day for services provided. Failure to make payment on the day and before close of business will incur additional administration fee as set by my doctor for the time and resources taken to recover full payment.
I understand a non-attendance fee as set by my doctor will be applicable for any missed appointments.
I understand a late cancellation fee as set by my doctor will be applicable for any appointments cancelled with less than 2 (two) hours’ notice.
If I am experiencing financial hardship, I will notify the Practice manager in writing prior to my appointment so that an appropriate payment pan can be devised and agreed between me and my doctor.
If I have any questions or concerns about any of the information on this form, I will request to speak to the Practice Manager or notify the Practice Manager in writing.
Please sign this form as confirmation that you have read, understood the appointment and fee information and consent to the use of your personal and health information as stated above.
You hereby acknowledge and consent to the disclosure and/or use of your personal health information by THE COTTAGE SURGERY PTY LTD ACN 093 271 393 and persons directly or indirectly involved in your personal health care or medical treatment for the purposes set out above.
