Therapy or Pain appointment registration

Therapy or Pain Appointment Registration

Dr Adele has a special interest in IFS therapy, mindfulness and self-compassion, complex trauma, modern pain neuroscience and the mind-body aspects of chronic pain. She is very happy to see patients for individually tailored long appointments.
Name

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Preferred name if applicable:
DOB
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Mobile
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Address

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Medicare Number:
Medicare position on card:
How did you hear about Dr Adele Stewart?
Please select all applicable to acknowledge you are aware of conditions of appointment (you may need to click on text box):

I am aware of the Cost: $285 ($245 card holders until safety net is reached) for a 60-65 minute face-to-face appointment. [We like to be able extend the appointment for you if that is what is needed at the time. If the appointment goes over 65 minutes the cost increases to $310 ($260). If the appointment goes over 75 minutes the cost increases to $350 ($285)]. You will receive a rebate of $202. No mental health plan required if face to face appointment. [For Telehealth only: same cost with rebate varying depending on several factors. With a Mental health plan you will receive $155 rebate. Adele will accept mental health plans from other GP’s.]
See Pain Explained Resources for free access to the 5 Pain Explained video modules, meditations, handouts, courses and more.

As you go through these keep a journal and take a note of any S.A.L.A.D!

What SURPRISES you?

What ANNOYS you?

What LOSES you?

What APPLIES to you?

What do you DISAGREE with?
Appointment required Face-to-face or Telehealth? (If you can make it face-to-face at least once you will receive much more from Medicare)
Approximate days and times that you would prefer:
Pain appointments: Brief details (or more extensive if you prefer) re pain history, interventions, surgery and medications. You may bring in xrays and scan reports for clarification if you like.
Therapy appointments: Brief details (or more extensive if you prefer) re background, mental health and medications.
Allergies? Please specify
Any other questions or comments.
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Therapy or Pain Appointment Registration