REFERRALS AND FUNDING

Will you be using any of the following Funding / Medicare Programs?

CONSENT TO BE VIDEOTAPED

CONSENT TO COLLECT & USE INFORMATION

As part of providing a quality service for your child, Melbourne Child Development will need to collect and store information about your child. In order to thoroughly assess, diagnose and provide therapy, we will need to also collect some personal information from you and from other professionals involved in your child’s care. This information and information concerning assessments, reports, diagnosis and treatment of your child will also be used for:

• The administrative purpose of running this practice including billing.
• In the case of insurance or compensation claims it may be necessary to disclose to the insurer and/or collect information from and for the insurer that affects the child’s return to pre-school and/or school.
• Handover if another Clinician within this Practice will be providing the child’s ongoing therapy.
• Disclosure of information to and collection of information from other professionals if the Speech Pathologist deems this is to facilitate the best outcomes for the child.

Melbourne Child Development has a Privacy Policy that is available upon request. This policy provides guidelines on the collection, use, disclosure and security of the information that is collected and held about the child.

I, the undersigned, have read the above information and understand and accept the reasons for collecting the information and the ways in which the information may be used.

I understand that it is my choice as to what information I provide in relation to the child and that withholding or falsifying information might act against the best interests of the child in the assessment and progress of the therapy.

I am aware that if, in exceptional circumstances, access to information from the child’s Speech Pathology file is denied for legitimate purposes, that the reasons for this and possible remedies will be explained to me.

I understand that this Practice must obtain additional consent if the information collected is to be used in any way other than that outlined above.

I am aware that I may rescind this permission at any time either verbally or in writing.

MORE THAN WORDS PROGRAM FEES

CANCELLATION POLICY

If you cannot attend a session, please provide a minimum of two business days notice. If less than two business days notice is provided, a fee of 50% of the cost of the session will be charged. Cancellation fees are usually the responsibility of the parent/carer as most funding and rebate programs do not cover these.

PROGRAM TERMS & CONDITIONS

• Enrolment in the More Than Words Program requires commitment to all sessions (Pre-Program Consultation, 8 Parent Group Training Sessions and 3 Individual Observation Sessions).
• It is a requirement that at least one parent attend each parent training session.
• An administration fee is required to enrol in the program for administration costs. This fee is non-refundable* and will be taken off the cost of the first session.
• A cancellation fee of 50% of the per session cost will apply if cancelled within two business days of the session time. Cancellation fees are usually the responsibility of the parent/carer as most funding and rebate programs do not cover these.

*Should Melbourne Child Development be unable to offer you a place in the More Than Words Program, any administration fees paid will be refunded.

ADMINISTRATION FEE PAYMENT

                                

 

This fee is for setting up the file and co-ordinating the Program.

This administration fee will be deducted from the cost of the Pre-Program Consultation. This administration fee is not refundable unless Melbourne Child Development are unable to offer you a place in the Program. 

Please Note: If you do not understand any of the information that is outlined in this document or if you have further questions, please do not hesitate to discuss these with the Practice Principal Robyn Stephen.