Patient Registration Form

Informed Consent. By submitting this form

  • I give consent for treatment at Central Victorian Hand Therapy.
  • I agree to this consent remaining valid until such time as I withdraw my consent.
  • I also agree and give consent for my case to be discussed with interested parties such as my GP or referring doctor / specialist.
  • I understand that if I cancel within 24 hours or fail to attend an appointment I will be charged a $25 non attendance fee on the first occasion and full fee on any subsequent occasion
  • I understand that I am liable for all fees until my TAC or Workers compensation claim has been formally approved and a claim number supplied to CVHT