Terms and Conditions Agreement
Prior to the commencement of any procedure, as part of our duty to fully inform you, we require an agreement to be formalised as to the rights and responsibilities of both the patient and Ashbrooke Medical institute.
We have found that patients appreciate full disclosure on the Terms and Conditions that prevail throughout the relationship between the patient and the Surgical Centre.
At the time of visiting the doctor, you will be given an itemised quotation for the intended procedure, copies of the Terms and Conditions Agreement, a Booking form if you wish to proceed and a Consent form which provides permission for us to perform your procedure(s). Please study these documents, as well as any information sheets provided to you about your booking. The opportunity to provide clarification of any concerns is welcomed and withdrawal of consent can be made at any time in accordance with the Terms and Conditions Agreement.
Terms and Conditions Agreement (for all Surgical Procedures)
The Procedure Fee relates to the fee charged by the doctor to perform the procedure and is paid directly to the Ashbrooke Medical Institute.
The Procedure Fee must be fully paid no less than 7 days prior to the intended procedure. Patients intending to by cheque must forward full payment no less than 14 days prior to the intended procedure.
Where applicable, GST is shown as a separate, additional charge.
The Theatre Fee is payable to the surgery facility where the procedure will be performed. The Theatre Fee incorporates consumable items used during your procedure. Theatre Fees are estimated in your quotation. (A Theatre Fee is shown on page 2 of this agreement). This estimate is based on the usual amount of time taken for the procedure intends to undergo. From time to time this charge may vary according to unforeseen factors pertaining to the individual patient. In the event of a procedure taking more time than originally expected Ashbrooke Medical Institute reserves the right to charge the patient in accordance with the schedule provided and shall be paid in full on the day of the procedure prior to the patient’s discharge. Theatre Fees are paid directly by the patient to the facility where the procedure is due to be performed. The Theatre Fees must be fully paid 2 days prior to the intended procedure.
A Cancellation Fee may be levied if the patient is unable to attend on the day of the booking. Cancellation Fees are necessary when it is not possible to fill the vacancy caused by the cancellation by the patient. The maximum amount of the Cancellation Fee will be $800. If applicable, the Cancellation Fee will be deducted from the deposit paid by the patient to Ashbrooke Medical Institute and forwarded to the facility where the procedure was due to be performed. Any balances will be returned to the patient.
Liposculpture only:The doctors always make all reasonable efforts within the realms of safety, to remove as much fat as required by the patient. In some circumstances, full fat removal is not possible and some patients may request further fat be removed after full recovery has occurred. This procedure is termed Enhancement. Patients must maintain their recorded post-operative weight in order for the Doctor to assess suitability for Enhancement. Enhancement will occur at the discretion of the Doctor, if Enhancement is deemed by them to be in the best interests of the patient. An Enhancement Service Fee is chargeable should Enhancement be requested and will usually constitute payment for Theatre fees only. Enhancement procedures will not usually be performed until six months after the original procedure.
In the rare event that a procedure has to be abandoned midway because of health concerns, the Doctor will resume the procedure at their discretion. Further Theatre Fee charges to the patient may apply if the procedure is rescheduled as a result of this interruption, or if theatre is extended.
There is a duty of care to the patient to discharge the patient into the care of a responsible adult when the time for discharge occurs. All patients must notify the facility where the procedure is to be performed, upon arrival on the day of their procedure, the name and contact details of the person nominated for this role. It is not permitted to discharge patients to leave by public transport.
In any case, patients are advised that driving motor vehicles or operating machinery can be hazardous up to 24 hours after the intended procedure due to reduced reaction times and errors in distance judgement.
In the event patients cannot be collected when ready for discharge, extra charges may be levied to cover the cost of nursing staff required to observe the patient during this time.
Liposculpture only:The Garment Fee relates to the compressiongarment required to be worn in the weeks following the procedure. The garment is necessary in providing support, aid healing and to be reduce the incidence of complications.
Patients recovery times rely on individual characteristics of the patient and the extent of work carried out. Most patients can return to sedentary activities within two or three days. Full mobility is usually returned in 14 days. Patients should allow for these factors when arranging time off work. Patients should also be mindful that in rare circumstances these times might be significantly extended in some patients.
Complications can occur with any procedure and these are explained in the literature provided in writing at the time of consultation. Acceptance of this Terms and Conditions Agreement includes acceptance of any complications that arises before, during and/or after the procedure and assumes that the literature on preparation for the procedure, complications and after-care provided has been read and understood by the patient.
Complaints Policy
Patient satisfaction is important to us. Please notify us of any concerns in writing as soon as is practicable. Complaints can be addressed to:
Complaints Officer,
PO Box 6090
Chapel St North
South Yarra
Vic 3141
All complaints will receive scrutiny and be replied to.
Refund Policy
It is essential that all patients understand that cosmetic enhancement is not an exact science. It is not possible for Ashbrooke Medical Institute or our Doctors to refund Procedure Fees. Ashbrooke Medical Institute and our Doctors will make every reasonable effort to achieve the aesthetic outcome the patient requests, however no guarantees or warranties are offered in relation to the effects of any procedure performed by the Doctor or other ancillary staff.
Theatre Fee Schedule
Procedure duration 1 hr $500 plus GST
Procedure duration 1-2 hrs $750 plus GST
Procedure duration 2-3 hrs $1200 plus GST
Procedure duration >3 hrs $1600 plus GST
Definitions: Procedure duration begins when patient enters procedure room and ends upon leaving procedure room. Procedure duration does not include pre-operative discussion time or bedstay following the procedure. However, prolonged bedstay time following the procedure after the Doctor has given discharge instructions to the nursing staff may incur further charges. ‘The Doctor’ pertains to the Doctor performing the stated procedure as contained in the document ‘Consultation’. ‘The Patient’ is the patient undergoing the stated procedure as contained in the document ‘Consultation’.
I________________________________ have read this document and agree to the
terms and conditions above, this_________ day_________ 20__.
Signed ________________________
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