Pain appointment registration

Chronic Pain Appointment Registration

Dr Adele has a special interest in modern pain neuroscience, especially the mind-body aspects of chronic pain and is very happy to see patients for individually tailored long appointments. She has a particular interest in Chronic Pelvic Pain. Depending on the case this will be a set of 1 hour + visits. Sometimes just 1 or 2 visits. Maybe up to 6 visits and sometimes ongoing 1-3 monthly visits.
Name*

Preferred First NameLast Name
DOB*
E-mail*
example@example.com
Mobile*
Medicare Number: *
Medicare position on card:
How did you hear about Dr Adele Stewart?
Please select all of the below 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. [For Telehealth only: similar cost with rebate varying from $0 to $202 depending on several factors. Mental health plan may be helpful. Adele will accept mental health plans from other GP’s or can prepare it for you herself if appropriate.]I'm aware of the cancellation fee of $100 if less than 4 hours notice is given. However as much notice as you can is appreciated.I'm aware that Dr Adele will not be taking me on as my usual GP. Prescribing appropriate medications is only a very small part of what she does.I'm aware that prior to attending the appointment for a Chronic Pain consultation that I need to view at least the first 2-3 of the modules on the below page. (Ideally take notes about what is applicable to you in particular and any questions that might come up. If these are unsuitable, please contact Dr Adele about shorter options.)
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:
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.
Allergies? Please specify
See Pain Explained Resources for free to access to the 5 Pain Explained video modules, meditations, handouts, courses and more.
Any other questions or comments.
Should be Empty:

Chronic Pain Appointment Registration