TERMS AND CONDITIONS OF THERAPY
By signing this form, you acknowledge that you have understood and agreed to:
Before you start with therapy the following will be discussed:
1.1. Treatment options and the benefits of each option
1.2. Any risks (such as risk of hurting yourself or pain) or possible negative aspects
You will then agree to the therapy after the discussions, or you may decide to refuse therapy. If you refuse, the consequences will be discussed. Therapy often means more than one session and it may be important that you commit to a series of sessions.
Every person that gets therapy in this practice has the right to confidentiality (this means to have your personal information kept private, even from family members and employers). Nothing that you share with the Therapist will be passed on to anyone, unless –
1. You agree in writing that your information can be shared (e.g. with a school teacher or an employer or anyother specific person or entity).
2. Should this practice be in contact with your medical aid, the following should be noted: The law on medical aids forces us to provide certain information to the medical aid. When your account is submitted to the medical aid, the account includes personal information, such as the codes (numbers) that indicate the specific therapy you received.
3. When we receive an order from a court to disclose your information, we have no choice but to provide it.
4. When a specific law makes it compulsory to report things, such as TB, cancer or child abuse or child neglect.
5. Communication with the referring doctor or other healthcare professional, insofar as it is necessary and in the interest of the patient.
6. Riana Henning takes video material of evaluations and sessions from time to time. These materials are used for record keeping, to monitor progress and to use during consultations with parents. She may request to use some of the material for teaching purposes. If this is requested you will be asked to give special consent for her to use the recording.
When anyone else, or any other business (such as an insurance company, your employer, a lawyer) want your information, we will contact you to get your written permission that we can give the information to such person
Parents and children
By law, children from the age of 12 can seek healthcare help on their own, if they are able to understand what therapy means. Parents still have to pay for this cost. Even if only one of the parents has completed the information above, any one of the child’s parents will have to pay the account for the child’s therapy. It does not matter if the parents are divorced or not married: any one, or both, may have to pay the account.
The above will be explained to children and parents or caregivers. If the child gives consent aspects of the proposed therapy and the outcome of therapy will be shared with the parent(s) or caregiver.
BILLING AND PAYMENTS
This Practice charges the fees it regards as appropriate in terms of the experience, services and training of the healthcare professional working in the Practice, as well as the cost-base of the Practice. Competition law dictates that different Practices may not agree to charge the same or similar fees.
A general fees list of the most common codes I charge is available on request directly from the therapist.
Fees are increased annually at the end of February of each year.
The Practice will provide patients with a price of goods and/or therapy structure and possible home programmes ahead of the detailed assessment, as well as after the feedback session discussing the evaluation results. Where it is unable to do so, it will provide a cost estimate. It should be noted that healthcare is not an exact numerical science, and the duration of services, the types of services or the number of items used cannot
always be exactly predicted in advance, as it depends on the specific patient’s health status, healthcare needs and/ or possible adverse reactions. Any changes that might occur will be discussed with you in order to proceed with your consent.
The cost of materials that the therapist may use during therapy may differ and I will in each case inform you of the cost thereof, if it is not included in the consultation fee.
Telephonic conversations and additional consultations held with relevant team members (e.g. school teachers, other therapists) will be charged separately. The amount charged is based on the amount of time spent.
In some cases recommendations to other Healthcare Professionals may be made, e.g. an Ophthalmologist, Optometrist, Speech and Language Therapist, etc. Such professionals will charge their own fees in addition to the fees of this Practice if they also render healthcare services to you.
This Practice is not contracted to any medical scheme and operates as a cash practice only. This means that all consultation, evaluation and intervention costs are the responsibility of the account holder. Please note that I do not submit to any scheme on your behalf. You are responsible for the full payment of the account, which it to be paid directly to the Practice.
The invoice supplied to you will be in a format that corresponds to the format accepted by Medical Schemes. Therefore you can use the invoice to submit to your Medical Aid – should you be a member of a Medical Aid – so that the Medical Aid can reimburse you.
An invoice containing the rendered services will be supplied to you once a month. Payment of the account is immediately payable. Should you not pay your account within 30 calendar days I will give you notice of 20 business days, where after I will refer your account to an attorney / a debt collecting agency. This will attract additional collection- and other fees. This Practice reserves the right to charge interest of 2% per month on overdue accounts.
If you are uncertain of a fee, please talk to your therapist about the cost of your therapy.
Please ensure that I always have your latest contact details to prevent you from missing any important communication from me. I may contact the person(s) indicated on your personal information form if I cannot get hold of you and your account remains unpaid.
Patients are encouraged to approach me early on if they experience problems with the payment of the account.
In deserving cases, I may reduce our fees to accommodate such patients.
Employment, insurance, Road Accident Fund and Compensation Fund (workplace injuries/disease) are dealt with according to the specific rules set by such bodies. Please inform me should you fall into these categories so that I can explain billing in these cases to you.
The banking details are as follows:
Account #: 011938595
Branch code: 001545
Please reference with your name and surname
4 Hour Cancellation Policy
Cancellation contact number : 0829403835
I understand that if an appointment is not cancelled with a 4 hour advance notice I will be charged in full for that session. I accept that appointments are taken as confirmed at the time of verbal booking. Any reminders from Riana Henning serve as a courtesy and have no bearing on the confirmation of an appointment.
I, the undersigned, accept that any late-coming will shorten the length of my session and I will be charged in full. Sessions cannot run overtime if the client is late.
I acknowledge that phone calls and emails that are longer than 10 minutes will be charged for.
I understand that that the email address and mobile number provided provided by me below will be used for all correspondence related to my appointments and invoices.
I understand that this practice makes use of a billing software called smeMetrics, all invoices will be sent to myself using this software.
I understand that this practices makes use of Kitrin (Pty) Ltd to manage all administration aspects of the practice including but not limited to invoice submission through smeMetrics, unpaids management and medical aid follow ups.
While every effort is made to ensure your child’s safety, the practice and the therapist cannot be held liable for any loss, injury or accident that may occur during therapy which is attributable directly or indirectly to the therapist. You hereby indemnify and undertake to hold the practice and the therapist harmless against any injury, loss or damage that you or your child may suffer arising either directly or indirectly from therapy or any service provided in terms of this agreement.
A Kind Reminder
No therapy can be 100% guaranteed.
You always have to follow the instructions and warnings of the therapist carefully.
The success of therapy depends on your co-operation and being honest with the therapist. If you feel uncertain, please make a follow-up appointment with the therapist.
You must complete a series of therapy sessions, if this was recommended by the therapist. Stopping therapy before the end of all the sessions, may mean that the therapy will not be successful.
Note that the information below with a ‘*’ is mandatory. If you don’t have this information, you can enter a ‘-‘. However, if the information is missing or inaccurate, it will result in a delay of the appointment scheduling, billing process and/ or medical aid follow-up process.
As per outstanding invoices processed by Riana Henning.