I acknowledge that I have the right to be informed about the costs of my medical treatment prior to giving my consent. This form outlines the estimated fees for my treatment provided by Dr Murray at Absolute Cosmetic Medicine, as well as other potential costs I might incur during my course of treatment.
Potential Additional Costs
I understand that the cost estimates provided to me (as per the quote sheet) are based on the proposed treatment and may vary due to changes in the actual treatment provided.
I am aware that I may receive separate accounts from other service providers associated with my treatment, including, but not limited to:
• Referral appointments, e.g., GP, Haematologist, Radiologist, etc. (if required)
• Additional garments (if required)
• Laboratory and diagnostic imaging fees (if required)
• Pathology fees: Claimable through Mediare; fees will apply if you do not hold a valid
Medicare card.
• Medication and pharmacy fees: Estimated at $50
• Chlorhexidine antibacterial body wash: Estimated at $10
• External carer cost/accommodation (if required)
• Revision costs / additional theatre fee
from $1390 (if applicable)
Please note: While every effort is made to provide accurate estimates, the actual costs may vary depending on unforeseen complications or changes in the treatment plan.
Payment Responsibility
I understand that as a private patient, I am responsible for all hospital, diagnostic, and prosthetic costs not covered by my health fund or Medicare. Since the procedures I am undergoing are cosmetic in nature and considered non-medical, elective procedures, I am aware that I will not be eligible for a Medicare rebate or health fund refund.
I, or the nominee named herein, commit to paying the indicated patient payment, along with any unforeseen costs that may arise due to the procedure(s).
Payment and Cooling-Off Period
I am aware of the 7-day cooling-off period after the second consultation, during which time no surgery bookings or deposits can be made.
I understand that full payment as per the invoice/quote provided in this communication is required 14 days prior to the procedure.
Acknowledgment
I confirm that I have read and understood this Informed Financial Consent form. I have been given the opportunity to ask questions about my treatment costs, and I am satisfied with the information I have received.
