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Patient Registration Form

Please complete all sections before your first appointment. This form collects the information required to register you with Focus Mind Care and facilitate safe, coordinated psychiatric care. It also includes our Privacy & Confidentiality Agreement, Financial Agreement, and Telehealth Information & Consent, which we ask you to read and sign.

Patient Registration

Your Details

Parent/Guardian (if under 18)

Are you completing this for someone under 18 years of age
Shared Parental Responsibility?
Court Orders affecting care?

Medicare Details

Date must be entered as on card eg. 01/2027

Emergency Contact Details

Referring Doctor

Is this your Family Doctor / GP?

Other Treating Health Professionals

Other Treating Health Professionals

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Brief Clinical Information

Privacy & Confidentiality Agreement

Privacy & Confidentiality Agreement

Legal consent for the collection, use and disclosure of your health information

Focus Mind Care is committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth), the Australian Privacy Principles (APPs), and applicable state health records legislation. This document explains how we collect, use, store and disclose your personal and health information, and asks for your consent to our standard practices.

Collection of Information

We collect personal and sensitive health information directly from you, and where relevant from your GP, referring practitioner, other treating health professionals, parents/guardians, and Medicare, in order to assess your needs, provide safe clinical care, and meet our legal and professional obligations, including those set out in the RANZCP Code of Ethics and the Medical Board of Australia's Good Medical Practice code of conduct.

Use and Disclosure

  • Your information is used to plan and provide your psychiatric care, and to coordinate with your GP and other treating practitioners.
  • We may disclose relevant information to your nominated emergency contact, referring GP, or other treating health professionals listed on your registration form, and to a support person or carer you have identified.
  • We may share information with Medicare, DVA, private health insurers, or pathology/imaging providers as required to process claims or investigations.
  • Information will only be disclosed to third parties without your consent where required or authorised by law — for example, a serious risk to the health or safety of you or another person, a mandatory reporting obligation (such as child protection legislation), or a court subpoena.
  • We do not sell or use your health information for marketing purposes.

Storage, Security & Data Breaches

Your medical record is stored securely in our clinical software system with restricted staff access, encryption, and regular backups. Records are retained in accordance with legal requirements (generally a minimum of 7 years from the date of last contact for adults, and until age 25 for patients who were minors at the time of treatment, subject to the requirements of the state or territory in which you were treated). In the unlikely event of a data breach that is likely to result in serious harm, we will notify you and the Office of the Australian Information Commissioner in accordance with the Notifiable Data Breaches scheme under the Privacy Act 1988 (Cth).

Telehealth-Specific Privacy Considerations

  • Where consultations are conducted by video or phone, we use secure, clinically appropriate platforms and do not use personal, non-clinical accounts to contact you.
  • We will ask about the privacy of your location before each telehealth consultation and discuss options if your space is not private or suitable.
  • We do not record telehealth consultations unless we have obtained your express informed consent beforehand; you should also let us know if you intend to record a session.

Access to Your Records

You have the right to request access to, and correction of, your health information at any time by contacting our practice in writing. A reasonable administrative fee may apply for large record requests.

Confidentiality of Minors

Where the patient is under 18, information may also be shared with parents/guardians with parental responsibility, except where the treating clinician considers this is not in the best interests of the young person, or the young person is assessed as competent to consent to their own treatment.

This document reflects the Australian Privacy Principles (Privacy Act 1988 Cth), AHPRA/Medical Board of Australia guidance, and RANZCP professional practice standards current at the time of writing.

Privacy & Confidentiality Agreement Concent

Financial Agreement

Financial Agreement

Fees, Medicare rebates, cancellations, scripts and reports

Consultation Fees & Medicare

  • Fees are payable in full at the time of your appointment, by card, EFTPOS or approved payment method.
  • Where a Medicare rebate applies (e.g. with a valid GP Mental Health Treatment Plan or referral), this will be processed on your behalf via Medicare Easyclaim where possible.
  • You remain responsible for the full consultation fee; the Medicare rebate is a partial refund, not a bulk-billed service, unless bulk billing has been specifically agreed.
  • Current fee schedules for initial and review consultations, including telehealth consultations, are available from reception and are reviewed periodically.

Informed Financial Consent

Consistent with Medical Board of Australia telehealth guidance, we will explain billing arrangements before your appointment, including whether a Medicare rebate applies, any gap payment you will need to pay, and whether fees differ between in-person and telehealth consultations. Please ask reception if you would like an estimate of your out-of-pocket cost before you book.

Cancellations & Non-Attendance

  • We require a minimum of 2 business days' notice to change or cancel an appointment.
  • Appointments cancelled with less than 2 business days' notice, or missed without notice, will incur a cancellation fee, which is not claimable through Medicare.
  • Repeated non-attendance may affect your ongoing access to appointments at this practice.

Scripts & Repeat Prescriptions

  • Prescriptions are issued following a real-time consultation (in-person, video or phone), consistent with Medical Board of Australia guidance that prescribing without a real-time consultation is not supported. Please plan ahead, as medication changes and repeat scripts are best managed as part of a review consultation.
  • Requests for scripts outside of a booked appointment are considered at the treating psychiatrist's discretion, may still require a brief real-time consultation, and may incur an administrative fee.

Reports & Letters

  • Standard correspondence with your GP or referring practitioner following a consultation is included in your consultation fee.
  • Additional reports (e.g. for schools, employers, insurers, medico-legal purposes, NDIS or Centrelink) are charged separately based on complexity and time required, with a quote provided in advance.
  • Please allow a minimum of 10 business days for non-urgent report requests.
Financial Agreement Acknowledgment

Telehealth Information & Consent

Telehealth Information & Consent

What to expect from video or phone consultations

About Telehealth

Telehealth consultations are conducted by secure video link or telephone, in line with the Medical Board of Australia's Telehealth Consultations with Patients guidelines and the RANZCP's Professional Practice Guideline 19: Telehealth in Psychiatry. Telehealth is generally most appropriate as part of an ongoing clinical relationship that also includes in-person consultations, and is not a routine substitute for face-to-face care. Video is preferred over phone, and is expected for initial assessments; phone consultations are generally reserved for well-known, lower-risk patients or when video is unavailable.

Before Your Appointment

  • Your treating psychiatrist will discuss whether telehealth is clinically suitable for you, considering your circumstances, digital access, and the nature of the consultation, and will explain the benefits and limitations of telehealth for your care.
  • You will be asked to confirm you have suitable technology, a private space, and know what to do if the connection fails (e.g. a fallback phone number).
  • You are welcome to have a support person, family member, carer or interpreter join the consultation; please let us know in advance so this can be arranged.
  • Billing arrangements, including any Medicare rebate and gap payment, will be explained before your appointment (see our Financial Agreement).
  • You will be advised if an in-person appointment is recommended instead of, or in addition to, telehealth.

During Your Appointment

  • We will confirm your identity, name, date of birth and current physical location at the start of each session, along with an emergency contact who could be reached if needed.
  • Your psychiatrist will explain their role and, for new patients, their qualifications and principal place of practice.
  • The same standards of informed consent, privacy, cultural safety and professional boundaries apply as in an in-person consultation.
  • Your psychiatrist will continue to assess, throughout the session, whether telehealth remains appropriate, and may recommend an in-person review if needed (for example, if a physical examination or higher-risk assessment is required).
  • Prescriptions, referrals and investigation requests can be issued following a real-time telehealth consultation; consistent with Medical Board of Australia guidance, we do not prescribe or provide care based on a questionnaire alone, without a real-time consultation.

Benefits & Limitations

  • Telehealth can improve access to care, reduce travel time, and offer flexibility for ongoing reviews, particularly for patients in rural, remote or otherwise underserved areas.
  • Physical examination, some risk assessments, and certain investigations cannot be performed remotely and may require an in-person visit.
  • Technical issues (e.g. poor internet connection or dropped calls) may occasionally disrupt a session; we will attempt to reconnect or move to a phone call, and will advise on rescheduling if needed.

Privacy & Environment

  • Please attend your telehealth appointment from a private, quiet location where you will not be overheard or interrupted, and let us know if this is not possible so we can discuss options.
  • We use secure, clinically appropriate platforms (not personal social accounts) to conduct telehealth consultations.
  • Sessions are not recorded by the practice. You should not record the session without your clinician's knowledge and express consent, and we will not record you without your express consent either.

Safety & Emergencies

Telehealth is not suitable for emergencies. If you are experiencing a mental health crisis or are at risk of harm, please contact emergency services (000), present to your nearest hospital emergency department, or call Lifeline on 13 11 14.

This document reflects the Medical Board of Australia's Telehealth Consultations with Patients guidelines and RANZCP Professional Practice Guideline 19: Telehealth in Psychiatry, current at the time of writing.

Telehealth Information & Consent

AI Scribe Consent

We use AI scribe to improve the quality and accuracy of medical communication.

This consent seeks your permission to use an AI scribe (medical AI transcription software) to capture and transcribe conversations between you and your clinician.

  • Your clinician may have an AI scribe running in the background during your consultation.
  • The AI scribe will listen to, and transcribe, your conversation.
  • The transcribed notes will be reviewed and verified by your clinician before being added to your medical records.
  • All notes, letters and transcriptions are securely stored and are only accessible to authorised personnel in our clinic, for a short period of time nominated by your clinician.
  • The information captured by the AI scribe is treated with the utmost confidentiality in accordance with the Australian Privacy Principles and the Privacy Act 1988.
  • Your personal and medical information will not be shared with any unauthorised third parties.
  • You have the right to withdraw your consent at any time without affecting your ongoing care.

 

By signing below, you acknowledge that you have read and understood the information provided above, as well as that provided verbally by your clinician. You consent to the use of an AI scribe during your consultations and the transcription of your conversations for the purpose of medical documentation.

Consent

Declaration & Agreement

Declaration Acceptance (Please select all)

Communication Preferences

Communication Preferences (Please select at least one)

How did you hear about us? *