From December 2001, the Privacy Act requires private medical practices to obtain your consent to collect personal information about you. Please read this Information carefully and sign where indicated below.

The medical practice collects information from you for the primary purpose of providing necessary healthcare. We require you to provide us with all your personal details and full medical details so that we may assess, diagnose, treat and be proactive in your health care needs properly and we will use the information you provide in the following ways:

* Administrative purposes in running our medical practice

* Billing purposes, including compliance with Medicare and Health Insurance Commission Requirements

* Disclosure to others involved in your health care, including treating doctor and specialists outside this medical practice. This may occur through referral to other doctors or for medical tests and in response or results returned to us following referrals.

* Disclosure for statistical research and quality assurance activities to Improve Individual and Community Health Care and Practice Management. Please be advised that your personal details such as your name, address and date of birth are withheld in these situations. Therefore, your identity is protected. You may elect for your information to be excluded in such activities. Please place a line through this clause if you prefer your information to be excluded.

I have read the information above and understand the reasons why my information must be collected. I am also aware that this practice has a privacy policy on handling patients’ information. I understand that I am not obliged to provide any information requested of me. But failure to do so might compromise the quality of health care and treatment given to me.

I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.

I consent to receive appointment & health reminders also health awareness via mobile number and/ or email.

I understand that failure to attend multiple appointments or notify Bray Park Family Doctors of cancellation of an appointment may result in a fee being charged of between $65 - $110 with no Medicare rebate.

If not a +65 year old pension card holder or child under 16 I am aware there may be practice fees involved with my consultation.