Informed consent:

Exercise Physiology Care is recognised as being an effective and safe method of care for many conditions. However, you must recognise that there are risks with all health care procedures which you should be informed about.

Please read carefully before signing:

I acknowledge that I have discussed with the accredited Exercise Physiologist the rare risks associated with my proposed care which include, although not limited to muscle and joint soreness, sprains and strains, nausea and dizziness, fractures, disc injuries, strokes, heart attack, hypoglycaemic episodes (or like episodes) and an exacerbation and or aggravation of my underlying conditions.
I have had the opportunity to discuss the proposed care with the accredited Exercise Physiologist. I also acknowledge that I have had the opportunity to ask questions about the nature, extent and purpose of the proposed care and I have been given sufficient time to decide giving consent for the care to proceed.
I acknowledge that I am aware of and understand the potential risks. I appreciate that results are not guaranteed.
I do not expect the practitioner to be able to anticipate all potential risks and complications associated with the proposed care.
I also give consent for my General Practitioner and/or Allied Health Professional to release relevant medical information to the accredited Exercise Physiologist as part of their proposed care plan.
I hereby acknowledge my consent to the performance of the proposed care by the accredited Exercise Physiologist. I understand that I can withdraw consent at any time. I understand that I have given my consent voluntarily without duress or inducements being directed at me.

Privacy collection:

We collect client information so we can provide the best possible care. At times we may need to liaise with our client’s other treating health practitioners and specialists where appropriate.
At times we may also be required to liaise with Medicare and our client’s private health insurance funds and may need to deal with lawyers engaged by our clients, or by their private health insurance fund.
As such, we may need to disclose or allow access to patient information to others for the purposes listed above.
All information provided is held in strictest confidence and will not be released without written permission of the client. The information on this form is sent to your medical file on our practice management system "Halaxy".

Cancellation policy:

If you need to cancel or reschedule an appointment, please ensure to provide at least 24 hours notice. Failure to do so will incur a $50 late cancellation fee. A no show attendance without notice will incur a 100% cancellation fee. These are not eligible for rebate. In exceptional circumstances this fee may be waived, so please discuss the reason for late cancellation with your Exercise Physiologist.

Georgia Ierino Exercise Physiologist

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