Territory Medical Group - Informed financial consent

This letter is to inform you of the fees associated with your appointment or procedure.

The Darwin Private Hospital, Anaesthetist, Pharmacy, Pathology and other services may send you an account if you require their services, dependant on your level of private health cover. Please check this with your insurer.

Your initial consultation will cost $265 (plus any costs for any procedure performed onsite at Territory Medical Group), this is payable on the day. Medicare will issue a rebate for this account if your referral is from a Doctor. Review consultations will cost $195 (plus any costs for any procedure performed onsite at Territory Medical Group), this is payable on the day. Medicare will issue a rebate for this account if your referral is from a Medicare Provider.

Operations: An invoice for surgery performed will be issued to you for payment in full. You will then be able to submit your receipt for any rebates available to you. 

Our Specialists require for payment in advance for all surgical procedures performed at The Darwin Private Hospital or The Royal Darwin Hospital. After your procedure has taken place a receipt will be sent to the patient for claiming from Medicare or/and your private health fund.

Should you have any questions or concerns, please discuss these with us at any time.

By signing this document you are consenting to having read and agreeing to the financial terms as outlined above.
 
 
Signature (parent/guardian if patient is under 16yo) *
clear
Thank you for completing this document.
Territory Medical Group - Specialists team