Informed Consent for Telehealth Services
* All fields are required
I have reviewed the following documents available at
needed to knowingly, and with informed consent, engage in telehealth services with Dr Nadine Pelling.
Professional Disclosure Statement for Dr Nadine Pelling.
Code of Practice/Confidentiality Information including standard limits and exceptions to confidentiality.
(Please note: Additional limitations to confidentiality exist regarding mandatory notification related issues for members of a profession governed by AHPRA)
Furthermore, I understand the following:
Dr Nadine Pelling's telehealth services are to be bulk billed when eligible for Medicare funding. If not eligible for Medicare rebate, my telehealth services will be charged at the standard bulk billing rate Dr Pelling would receive under Medicare.
Cancellation Policy – $50 fee for late cancellation/reschedule/nonattendance on 3rd occurrence.
Appointment SMS/text message reminders will be sent to my mobile the day prior to meeting (often via the Halaxy messenger service).
After having reviewed the above information and by clicking 'submit' as follows, I agree to meet with Clinician: Nadine Pelling Using telehealth videoconferencing or phone contact. I can discuss/ask questions about any of the before mentioned items at any time.
An email copy of your 'Client Informed Consent' will be sent to Nadine Pelling.