Please carefully review the Terms and Conditions Agreement when using Nicolise Goosen Physiotherapy Inc services. We highly regard your privacy, feedback and recommendations.
CONSENT FOR TREATMENT
This consent is contingent upon the physiotherapist conducting the requisite safety assessments and evaluations, taking appropriate precautions and providing a comprehensive explanation of the potential benefits, associated risks and available alternative procedures and modalities. I acknowledge that, as part of the treatment and assessment process, it may be necessary to expose certain specific areas of the body. I reserve the right to decline such exposure if I ever feel uncomfortable during the process.
CONSENT TO THE RELEASE OF INFORMATION
Personal information supplied by the patient as well as medical records and diagnosis are protected in terms of the POPI legislation. My physiotherapist may
however, use any of the details provided to pursue payment for any unpaid accounts. It is also acknowledged that my physiotherapist may share and/or refer to the details supplied by the patient as well as patient records to other medical professionals in the course of the medical treatment required for treatment, and/or any other party with whom the physiotherapist has a contractual agreement to do so. I authorize my physiotherapist to access my medical aid with my personal medical details.
COMPLAINTS AND CONCERNS
Nicolise Goosen Physiotherapy Inc promotes open communication for feedback, suggestions, and concerns. I hereby commit to following the practice’s policy, which encourages addressing and discussing issues or complaints with the practice and its staff members before involving external parties or individuals.
BOOKING CANCELLATIONS
This practice enforces a 3-hour cancellation policy, which means that if you need to cancel your appointment, you must do so at least three hours in advance. This policy is in place to maintain a fair, efficient, and respectful healthcare environment for both patients and healthcare provider. It aims to maximize the use of available appointment slots, minimize disruptions, and ensure that patients and professionals can make the best use of their time.
RESCHEDULING APPOINTMENTS
Patients have the option to independently reschedule appointments using the online booking system or have Nicolise Goosen Physiotherapy Inc do so on their behalf, provided this is done a minimum of three hours prior to the appointment.
FEES AND PAYMENT
Patients are personally responsible for any short payment of accounts by the medical scheme and / or the main
member of the medical aid on the basis that the medical services were rendered to said patient, or minor child.
It is acknowledged that all accounts in respect of the services rendered are due and payable within 30 (thirty) days from
the date upon which the service was rendered and that the information supplied will be communicated to said patient of the account.
Patients accept that interest will be levied on amounts outstanding for more than 30 days from the date of statement at today’s prescribed interest rate in terms of the Prescribed Rates of Interest Act 55 of 1975.