New Patient Form.

I confirm I wish to communicate with IMH Gold Coast via email/text and I understand that:

It is my request to use email / text;
Email / text is not a totally secure system for sending and receiving information;
Any decision to use email / text communication will be documented in my clinical records;
Emails may be printed and stored in my clinical records;
Text communications may be documented in my clinical records;
No emails - either sent by me or the staff member will be forwarded to anyone else with consent of any party;
Any decision made by myself to stop the use of email / text will be respected upon written notice. Any resumption will therefore require a new Consent Form;
Confidentiality will be respected by staff at all times.
I am signing to confirm that I have understood the conditions as set out above and have been made aware of the associated risks with regards to data protection.

This is a private billing practice and fees are based on the length and complexity of the consultation and the doctor seen. You may also be eligible for a medicare rebate. We will confirm the consultation fees upon booking.