Please note:

• Fee exemption: I understand that fees do not apply to clients in South Western or Central and Eastern Sydney or Nepean Blue Mountains (PHN funded service).
• 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.