Payment is strictly by cash, cheque or PayPal.
Should the patient/client/customer for any reason fail to pay monies owing to the Optimal Health Clinic (OHC), they shall incur a $120 debt recovery fee and all legal costs relating to recovering the debt.
If I am an ACC client and for any reason ACC does not pay for my appointment, I the client will pay what ACC would have paid the OHC, to the OHC.
Failure to give at least 24 hours notice when cancelling an appointment may result in a charge of $40.
The accompanying Patient Information sheet, Fee Schedule and Patient History form must be read and completed prior to the patient’s first consultation or treatment.
Refunds and exchanges: Sorry we are unable to offer exchanges on any services. All Melaleuca, Nu Skin and Pharmanex products have a 90 day money back guarantee. Due to all other suppliers refund policies, sorry but we are unable to offer you a refund on all other products.
I agree to answer any questions that the OHC may have at any time in relation to the success or failure of my treatment and the delivery of the services & products provided at the OHC.
I am happy to receive emails from the Optimal Health Centre.
Authorisation to Collect and Release Information under Requirements of the Privacy Act 1993 and Health Information Privacy Code 1994.
I authorise the collection and release of any information about me to the extent that it is needed to determine cover and/or assess my entitlement to compensation, rehabilitation assistance and medical treatment.
I hereby authorise any medical doctor, medical specialist, registered pharmacist, health practitioner or other person, any hospital, any medical service organisation, any insurance company or other institution or organisation to release to you and you to them any medical or other information acquired concerning my medical condition or other disabilities. A photocopy or fax of this authorisation shall be as valid as the original.
I have the right to see this information.
Other Points to Note
You may be asked to remove certain items of clothing to enable better access to different parts of your body you can expect to have a towel, blanket or robe to cover you.
Some questions that you maybe asked might seem irrelevant to you but they are helping the practitioner make a holistic diagnosis
If you feel uncomfortable in any way at any stage of the treatment for any reason please tell the practitioner as there may be some way to make you feel more comfortable. We will not take offence and will make every effort to make you feel as comfortable as possible.
You are welcome and encouraged to bring a support person with you to your appointments.
You have the right to decline or withdraw my consent to treatment at any time.
I understand that this authority relates to all aspects of my treatment and allows the release of information between medical practitioner, specialists, health professionals, hospitals and insurance companies. The information will be collected, held and used in accordance with the terms of the Privacy Act 1993 and the Health Information Privacy Code 1994. I have the right to see this information.
I acknowledge I have received an explanation and understand the type of treatment I am about to receive. I agree to the terms and conditions above, and those policies/procedures outlined in the accompanying sheets as stated in Terms & Conditions number 4 above. (If patient is under 18 years old, a parent or legal guardian must sign this form)
Name: (Please Print) _______________________________________________
Date of birth: _____________________________________________________
Your relationship to patient (if patient is under 18 years old)