I understand that Dr Adam Mir is a private billing practitioner and will not Bulk Bill.
A non-refundable pre-payment of $100 must be made to secure the appointment. The remaining balance to be paid on the day of consultation.
The above fees do not include any injections or treatments on the day.
Cancellation Fees:
If appointments are cancelled, rescheduled within 48 hours of the scheduled appointment or patients do not attend, a $100 cancellation fee will be charged. No further appointments will be made until the fee is paid.
If the patient is a Workcover/DVA or ADF patient, this cancellation fee will be paid by the patient personally and not covered by the third party.
SMS Confirmations
We will send an SMS reminder 7 days and again at 4 days before your appointment.
Please reply “Y” if you can attend or “N” if you wish to cancel/reschedule.
All appointments need to be confirmed within 48 hours of your appointment.
If you have not replied to the confirmation SMS and/or not completed this form we will assume you are not attending and the appointment will be cancelled.
I give my consent for my treating physician/provider to collect, use and disclose my personal information to medical staff and allied health potentially involved in my treatment as outlined in the Privacy Act 1988 and national privacy principles. This can involve discussing my medical history, diagnoses, and care preferences at a case conference, which may be billed to Medicare.
If I would like to know more or if there are certain aspects of my medical history or personal information that I would like withheld I will discuss this with my physician/provider during my appointment.
I agree to the collection and confidentiality of my personal information in my electronic file. I allow the practice to send me reminders via post, email, telephone or SMS for appointments or health matters.
