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.

The staff at IMH Gold Coast may request your previous testing results on behalf of your treating practitioners. These may include, but are not limited to pathology, radiology, and any relevant specialist treatment reports from third party providers.