Gynaecology - New Patient Form Logo
  • Gynaecology - New Patient Form

  • Personal Details

  •  - -
  •  - -
  • Gynaecology Consultation and Procedure Fees


    This document provides information regarding the fees associated with your gynaecology consultation and any procedures performed by our Specialist Gynaecologist, Dr Manisha Doohan.

    We are committed to delivering professional, high-quality healthcare throughout your consultation and procedure to ensure the best possible outcomes.

     

    Gap Provider Information


    Dr Manisha Doohan is a known gap provider

    Out-of-pocket costs will vary depending on the type of procedure and may be up to $2,000. *Effective for surgergies booked after 09-04-2026*

    At the time of your consultation, you will be provided with a written quotation for your procedure. This quotation will clearly outline the expected costs of your surgery.

     

    Payment Information

    Payment of gynaecology consultation fees is due IN FULL on the day of your consultation.


    Payment of the quoted gynaecology surgery is required IN FULL at least 14 days prior to surgery

    Payment can be made via direct deposit or EFTPOS

    PLEASE NOTE:
    Failure to make payment within the required timeframe will result in cancellation or postponement of your surgery.

     

    Additional Fees

    Please be aware that the quoted fees do not include services provided by external providers, including but not limited to:

    South Perth Hospital
    SJOG Murdoch
    Anaesthetist
    Surgical Assistant
    Pathology
    Radiology
    These services will be billed separately.

  • Image-48
  • Powered by Jotform SignClear
  • REFFERALS:

     It is the patient’s responsibility to ensure that their referral is current and valid at the time of their appointment.

    Referrals from a General Practitioner (GP) are valid for 12 months

    Referrals from a Specialist are valid for 3 months

    Please check with reception if you are unsure about the validity of your referral or have any questions.

     

    SURGERY:

    If you require surgery, Dr Manisha Doohan operates at:

    South Perth Hospital

    St John of God Hospital, Murdoch

    An Estimate of Costs for surgery will be provided to the patient following their initial consultation

     

    DECLARATION – TO BE SIGNED BY ALL PATIENTS:

     Appointments:

    If I am unable to attend my appointment, I will provide a minimum of three (3) business days’ notice to cancel or reschedule.

    If I do not cancel or reschedule my appointment within three (3) business days, I accept a $70 late cancellation fee.

    If I do not attend my appointment, I accept a $170 non-attendance fee.

    If I arrive more than 15 minutes late for my appointment, I understand that my appointment will need to be rescheduled.

    Outstanding Accounts:

    If my account remains outstanding for longer than 60 days, I agree to be responsible for any additional costs incurred, including fees associated with a debt recovery agency.

     

    PRIVACY ACT 1988 - PATIENT TO CONSENT & DISCLOSE INFORMATION

     The Privacy Act 1988 requires medical practitioners to obtain patient consent to collect, use, and disclose personal information.

     COLLECTION OF INFORMATION

    We collect information necessary to provide appropriate medical care, which may include:

    Medical and surgical history

    Family medical history

    Ethnicity

    Contact details

    Medicare and/or private health insurance details

    Genetic information

    Billing and account details

    Information is usually collected directly from you. In some circumstances, we may need to obtain information from other sources, including:

    Other medical practitioners (e.g. previous GP or Specialist)

    Other healthcare providers (e.g. physiotherapists, psychologists, pharmacists, hospitals, and day surgery units)

    Both medical practitioners and practice staff may participate in collecting this information.

    In emergency situations, personal information may be obtained from relatives or other sources if prior consent cannot be obtained.

     

    USE & DISCLOSURE:

    With your consent, your information may be used or disclosed for:

    Billing and account management

    Referrals to other healthcare providers

    Sending specimens (e.g. blood tests, Pap smears) for analysis

    Hospital admissions or specialist advice

    Providing medical advice and treatment

    Practice management and administration

    Quality assurance, accreditation, and complaint handling

    Meeting obligations to medical defence organisations or insurers

    Preventing or reducing a serious threat to health or safety

    Legal requirements, including court orders, mandatory reporting, or notification of certain communicable diseases

     

    ACCESS TO HEALTH RECORDS

    You are entitled to access your health records at a mutually convenient time.

    Access may be denied if:

    It poses a serious threat to life or health

    There is a legal restriction

    It unreasonably impacts the privacy of another person

    The request is frivolous or vexatious

    The information relates to legal proceedings

    Access would compromise national security

     

    Requests should be made in writing where possible. Fees may apply for photocopying or staff time.
    If you believe information is inaccurate, you may request correction. Original records will not be erased but corrections will be documented and attached to your file.

     

     

  • Powered by Jotform SignClear
  • INFORMATION ON PELVIC EXAMINATION:

    Your consultation may involve a pelvic (intimate) examination. The purpose of this information is to help you understand what this examination may involve.

     THE EXAMINATION MAY INCLUDE:

    Abdominal palpation – gentle examination of the abdomen using hands

    Inspection of the vulva – visual examination of the external genital area

    Speculum examination – insertion of a speculum to view the vagina and cervix

    Collection of tests – such as vaginal or cervical swabs

    Digital vaginal examination – one or two gloved fingers inserted into the vagina while the other hand examines the abdomen to assess pelvic organs

    A chaperone will be offered for all pelvic examinations. You may decline a chaperone if you wish and if your doctor agrees.

    Some clothing items may need to be removed for the examination. A modesty sheet will be always provided.

    Your doctor will explain:

    Why the examination is recommended

    What it involves

    You will always have the opportunity to decide whether to proceed.

     Please raise any questions or concerns with your doctor.

  • Powered by Jotform SignClear
  • LYREBIRD HEALTH CONSENT:

    This clinic uses Lyrebird Health, a medical scribe tool designed to assist health practitioners in accurately documenting clinical notes during consultations.

    Key information regarding Lyrebird Health:

    - Transcription is performed exclusively within Australia.

    - Audio files are destroyed immediately after transcription.

    - Transcriptions are redacted of sensitive personal identifying information.

    - Transcripts are encrypted and not stored in their original audio form.

    - Only your treating health practitioner can access this information.

    - At the discretion of the practitioner, data may be stored temporarily in Lyrebird Health.

  • Powered by Jotform SignClear
  • Should be Empty: