Patient Details

Patient Details

COVID-19
Due to the current health advice surrounding the Coronavirus (Covid-19), you must agree you have NOT travelled overseas within the past 14 days, OR come in contact with someone that has tested positive for Covid-19. You must also agree you are NOT showing any cold or flu-like symptoms, including sore throat and fever and that you will bring only ONE support person with you to your appointment.

I AGREEI DO NOT AGREE

Title:
Family Name:
First Name:
Preferred Name:
Address:
Post Code:
Date of Birth:
Phone: Home: Work: Mobile:
Fax:
E-mail:
Ref No: Medicare No: Expiry:
Occupation:
Next of Kin:
Relationship:
Contact Number (Only in an Emergency): Home: Mobile:

Sunshine Coast Brain & Spine ensures all measures are taken to protect the patient’s privacy. In the event that Sunshine Coast Brain and Spine need to contact you, we will attempt to contact you on the above listed contact numbers. Should you have an answering service attached to the above contact number/s or if another member of your household answers, please sign below to consent to Sunshine Coast Brain & Spine leaving a message for you.

If you do not wish a message to be left please indicate below.

Do ConsentDo Not Consent

Sunshine Coast Brain & Spine to contact me on the above contact number/s and request that a return message be left in the event that I am unable to speak with Sunshine Coast Brain & Spine directly.

Private Health Fund (Hospital Cover only)
Membership Number: Ref No:
(If Workcover) Claim Number:
Case Manager:
This practice does not bill to third parties such as WorkCover without previous written approval being received from your Case Manager.
IF YOU ARE NOT THE PERSON RESPONSIBLE FOR THE ACCOUNT YOU WILL NEED TO SUBMIT DOCUMENTATION OUTLINING THE PERSON RESPONSIBLE FOR THE ACCOUNT (THIS APPLIES TO PRIVATE PATIENTS ONLY)

Please ensure that you also complete the Privacy Policy Agreement.

COVID-19 Patient Message** IMPORTANT INFORMATION **

Patient and staff safety is our highest priority at Sunshine Coast Brain & Spine.

For patients with appointments, if you are suffering any symptoms such as fever, dry cough, sore throat, tiredness or shortness of breath or have recently traveled or been in contact with someone who has returned from overseas, please contact our friendly reception team before attending the clinic. A telehealth appointment may be an alternative method of speaking with our surgeons.

Protecting the health of our staff is vital to ensure they can continue to provide great service.  Patients are encouraged to prepay accounts over the phone prior to appointments or via payWave or other contactless payment methods. Patients are also asked to complete the Patient Details Form and sign the Privacy Policy Agreement electronically prior to their appointment. These forms can be found under our Contacts page on the website or by clicking here. Please note, patients are asked to bring only ONE support person to their appointment and maintain appropriate social distances to help reduce the risk of COVID-19 transmission.

During this current outbreak of COVID-19 coronavirus we want to assure all of our patients that we will continue to implement procedures to maintain a hygienic clinical environment. This includes:

-          Disinfecting and wiping down all treatment surfaces

-          Regular cleaning of rooms and shared equipment

-          Thorough cleaning of all communal items including reception chairs, tables, door handles, pens and other shared items

-          All staff have access to infection control procedures and training to implement these as necessary

We are carefully monitoring the directions and advice of Queensland Health, the Australian Government Department of Health and the World Health Organization. In the meantime, it is still business as usual and our doors are open.

Sunshine Coast Brain & Spine wishes to apologise for the inconvenience caused and thanks you for your cooperation and understanding during this unprecedented situation.