Consent to Policies regarding healthcare for
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PATIENT'S NAME
First Name
Last Name
Patient's Date of Birth
*
MM
DD
YYYY
I consent and agree to the policies, including the requirements, responsibilities, terms and conditions for acceptance and holding an appointment, requesting the commencement or continuation of a healthcare relationship with the associated provider and provision of their healthcare services to this patient and liaising with the Prosper Paediatrics staff as they provide administrative and reception services on behalf of the associated provider. I understand these policies have been published on this website in the menu "For Patients & Families" and are also explained, summarised, referenced or linked in the Booking Emails and other written communications sent to me. If needed, I will have them translated from English to my preferred language or can seek clarification from Prosper Paediatrics to ensure I understand them. I will confirm my agreement to all these policies by checking each of the policy areas summarised as follows:
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Consent to policies is given by the Patient if 16 years or more of age or, if younger, by their Parent/guardian:
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First Name
Last Name
Email
*
Thank you! We will allocate an appointment and send a Booking Email. Please read, check, and save the Booking Email, and contact us if you have any questions or concerns.
