← All resources / Patient forms

Informed financial consent form

Explains fees, what a health fund or scheme may cover and the gap, before treatment starts.

How to use it: Physiotherapy Invoicing and Claims: Medicare, DVA, WorkCover, NDIS and Health Funds

Fees

  1. Your fees and rebates To read and agree to · required Our current fees are listed at reception and on our website. Your physiotherapist will tell you the expected number of visits and the likely total before treatment continues. If you have private health insurance, the amount your fund pays depends on your cover; you pay the difference (the gap). Some treatment may be covered by a scheme or insurer only when it has approved it first; we will tell you if that applies.
  2. I understand the fees and how payment works Tick box · required

Signature

  1. Your full name Short answer · required
  2. Date Date · required

Signature

The patient signs on screen, on their phone or at the front desk, and the signed copy is kept on their file.

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.