We require your consent to collect personal information about you. Please read this information carefully, and tick to the terms and condition box above.
This medical practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and a full medical history, so that we may properly assess, diagnose, treat and be proactive in your health care needs. This means we will use the information you provide in the following ways:
I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of the health care and treatment given to me.
I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.
I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.
I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify this practice of.
Request for the release of medical history from the Leongatha Healthcare Pty Ltd to another clinic will incur a fee of $22.50. The request for the medical history will not be processed until any outstanding accounts are paid in full.
I understand that a fee of $30 applies to any missed appointments where I fail to advise the clinic at least 2 hours prior to the appointment time.