Glow Group Health and Wellbeing Consent Form
As part of providing a Dietetic service to you, Glow Group Health and Wellbeing needs to collect and record personal information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information as part of providing Dietetic services to you. This collection of personal information will be a necessary part of the nutrition assessment and treatment that is conducted.
All personal information gathered by the Dietitian during the provision of the nutrition consult will remain confidential except when:
Your personal information is not disclosed to overseas recipients, unless you consent or such disclosure is otherwise required by law. Your personal information will not be used, sold, rented or disclosed for any other purpose.
Fees are paid after your consultation session and are non-refundable.
Medicare - Rebates for Dietitian services are available through Medicare for clients under a Chronic Disease Management Plan (previously known as Enhanced Primary Care or EPC) or a Medicare Eating Disorder Plan. To qualify for these rebates, a referral is required from your GP. Glow Group Health and Wellbeing does not bulk bill, so we do ask that clients kindly pay the difference between the fee charged and the Medicare rebate.
Private Health - Most private health funds offer coverage for Dietitian/Nutrition services as a component of their extras cover. If you are unsure of your coverage we recommend contacting your health fund to see whether you are eligible. Should you have any questions or queries regarding the claiming process the Glow Group team is very happy to help.
For us to provide you with the best and most accessible service, there are fees for cancellations and missed appointments. In order to avoid these fees, please provide us with as much notice as possible.
50% of usual Session Fee applies
Full Session Fee applies
Cancellation fees are charged as this time has been set aside for you and cannot be filled at short notice. These fees are not covered by Medicare; they are your responsibility, and become due immediately.
Glow Group Health and Wellbeing reserves the right to reschedule appointments at any time, without compensation, if it is deemed necessary due to staff illness or other unforeseen circumstance.
Consistent therapy is beneficial for progress, therefore, if more than 2 consecutive cancellations or non-attendance occur, further scheduling of appointments will need to be reviewed.
Your treating Dietitian will not be able to attend to your calls after hours, and outside of sessions. In the event of a crisis please reach out to your GP, or after hours GP. In the event of an emergency please dial 000 or present at your nearest hospital.
I, have read and understood this Consent Form. I agree to the above conditions for the Dietetic Consult provided by a Glow Group Health and Wellbeing Dietitian.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Glow Group Health and Wellbeing Consent Form
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