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*

First Name on medicare cardLast Name on medicare card
Preferred name if applicable:
DOB*
E-mail*
example@example.com
Mobile*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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.]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.Pain appointments only: 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.)
See Pain Explained Resources for free access to the 5 Pain Explained video modules, meditations, handouts, courses and more.
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