Please note that if your claim has not been approved you will need to pay for your consult onthe day and seek reimbursement.

There may be an“out of pocket expense”.

PAYMENT ISREQUESTED AT TIME OF SERVICE. WE ACCEPT CASH, CREDIT

CARDS AND EFTPOS!

A 24 HOURCANCELLATION NOTICE IS REQUIRED IF YOU’RE NOT ABLE TO ATTEND THESESSION TIME OTHERWISE A PAYMENT IS REQUIRED FOR THE SESSION NOT ATTENDED. THIS WILL ENABLE OTHER CLIENTS TO USE THE ALLOTTED TIME. IF RUNNING LATE FOR YOUR APPOINTMENT, THE SESSION WILL BE SHORTENED SO THAT THE NEXT CLIENT IS NOT INCONVENIENCED.

PLEASE CHECK THE BOX TO ACKNOWLEDGE AND ACCEPT RESPONSIBILITYFOR PAYMENT OF ALL SESSIONS.

I consent toSmart Health Training & Services obtaining and giving information, both verbally and in writing, to/from other Health Professionals pertaining to the medical conditions, where relevant, to the treatment being received at SmartHealth Training & Services. These professionals may include your GP,Case Manager, Radiologist. Etc

InformationConsent *select one