Please note:

• Fee schedule: I understand that the fee schedule outlined above applies only to services provided within Australia and that higher fees may be applicable for individuals residing outside of Australia.
• Card payment surcharge: I acknowledge that payments made by credit or debit card incur a 1.7% card payment surcharge, which will be applied to my consultation fee.
• Privacy and Information Collection: I acknowledge that information provided will be collected in accordance with the privacy policy outlined on our website. This includes the provision of deidentified information to PHNs for PHN funded services.
• Billing: I understand that certain services may be bulk billed (including the interview of a person other than the patient– 92458, 92459 or 92460).
• Medicare Claim Submission: I agree to the fees outlined above and authorize Dokotela to submit my claim to Medicare on my behalf (if applicable).
• Use of AI tools: I agree to and understand that my treating specialist/doctor may use secure and trusted AI tools to assist with transcribing the appointment, preparing the treatment letter, medical records, and other notes. These tools are carefully chosen to enhance accuracy, efficiency, and the quality of documentation, ensuring clear communication and the highest standard of care for my treatment.
• Emergency Contact Consent: I consent to Dokotela contacting my designated emergency contact in the event of an emergency.
• Cancellation Policy: Our cancellation policy requires at least 48 hours' notice. Appointments that are missed or cancelled with less than 48 hours' notice will incur a cancellation fee equal to the full cost of the appointment. If a deposit has been paid, it will be retained and applied toward the cancellation fee.