Please complete the consent form 48 hours prior to your appointment.

1A Williams Avenue, St Morris, SA 5068.

129 Marion Road, Richmond, SA 5033.

Phone: (08) 8423 6477

Fax: (08) 8311 1755

admin@specialistplus.com.au

1A Williams Avenue, St Morris, SA 5068.
Phone: (08) 8423 6477
Fax: (08) 8311 1755
admin@specialistplus.com.au

Please complete the consent form 48 hours prior to your appointment.

Consent Form

All clients are required to complete the consent form below 48 hours prior to an appointment.






    Medications


    Patient Authority


    Your authority for the release and collection of medical information


    I authorise and consent to any health professional, legal representative, rehabilitation provider, case manager and Specialist Plus providers disclosing, releasing, or discussing records containing my personal medical information, between one another. I understand that the medical information is required for the purposes of determining and managing my compensation claim, to assist with my treatment.


    I authorise and consent to a photocopy of this Authority being sufficient evidence of my authority and consent to discuss or provide the medical information requested.