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  • Cygnet Clinic Patient Registration Form

    Completed 1st, 6th, 10th Sessions

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  • Patient Information Form

  • Medicare Direct Online Claiming

  • Medicare rebates for our services have been available for the majority of our patients referred under the Better Access initiative.  Since Cygnet Clinic opened, we offered Medicare Rebates through our EFTPOS terminal.  Although this is convenient, it does require manually entering your referral details for every visit which is time-consuming. 

     

    To make this process quicker, we are transitioning to Medicare Online claiming. This allows your rebate to be processed automatically at the end of the session without the need for EFTPOS to be used. 

     

    To allow Cygnet Clinic to deposit directly into your account, we require the following details.

  • Bank Account Details for Medicare Rebate Deposit

    Optional Section - for quick deposit into your bank account. You can skip this section if you have already registered your bank details with Medicare. Entering your bank details on our system will speed up the rebate process.

  • If you already have registered your bank account details with Medicare and choose not to register these details with Cygnet Clinic, the rebate may take longer (up to 3 working days) to clear into your nominated account.

  • K-10 Assessment

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  • Depression, Anxiety, Stress, Scale (DASS - 21)

  • Please read each statement and tap a number 0, 1, 2 or 3 which indicates how much the statement applied to you "over the past week".  There are no right or wrong answers.  Do not spend too much time on any statement.

    The rating scale is as follows:

    0  Did not apply to me at all

    1  Applied to me to some degree, or some of the time

    2  Applied to me to a considerable degree, or a good part of time

    3  Applied to me very much, or most of the time

  • By signing below, you agree to the terms and conditions of services provided by clinicians at Cygnet Clinic, including the use of automatic payment methods such as debit or credit payments for services provided.  You acknowledge that you have received a Patient Information Form outlining the limits of confidentiality, use of security cameras, fee structure and services provided by clinicians at Cygnet Clinic.  This includes fees for late cancellation or failure to attend without notice will be automatically billed.

    By signing this for you understand that Cygnet Clinic is not a Mental Health Emergency Service as outlined in the information form provided to you.

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  • Thank you - Please Tap Submit Below

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