Practice Policies – Atlus Connect Pty Ltd
- I acknowledge that I have reviewed and agree to the clinic’s fee schedule.
- I agree to receive minimal promotional emails about clinic specials and upcoming events/seminars associated with Atlus.
- I agree to the disclosure and use of my personal health information by Atlus, related partners and associates and other health care providers involved in my health care.
- I agree to provide Atlus with details of my consent for a nominated person to act on my behalf if applicable.
- I acknowledge all consultations will be via telehealth.
- I consent to receive SMS reminders, messages and emails.
- I agree to my prescriptions and any subsequent repeats being sent to the Atlus in house dispensary – Monivea Road.
- I understand that my prescriptions and any subsequent repeats will not be sent to an external pharmacy.
- I understand that Atlus will not tolerate any form of rude, aggressive or threatening behaviour towards a member of staff.
- I am aware that all consults require full prepayment to secure a booking and that Atlus is a fully private provider.
- I understand Medicare or Private Health insurance rebates cannot be claimed for consults.
- I am aware that Atlus only accept card payments (VISA, Mastercard, EFTPOS).
- I am aware that a minimum 24 hours notice is required to reschedule a consultation otherwise the full fee will be forfeited.
- I agree that refunds are not provided if I cancel or fail to attend a consult.
Plant Based Medicine
- I am aware that I must provide a health summary confirming my current diagnosis and medications.
- I understand the documentation provided will be reviewed and verified prior to issuance of prescriptions, if appropriate.
- I am aware that the cost of plant based medicines prescribed are not included in consult fees and I am fully responsible for the total cost and purchase of all plant based medicines.
- I confirm l will review any product information leaflet provided to me.
- I understand that there is no guarantee this treatment will improve my condition or my symptoms.
- I acknowledge that an additional appointment will be required if I need a change of product or additional prescriptions.
- I understand the long term effects of plant based medicine is unknown and the potential risks and complications associated may include changes in level of sedation, lethargy, fatigue, dry mouth, nausea, vomiting, diarrhea, drowsiness, dizziness, disorientation, agitation, balance problems, changes in memory, paranoid delusions or hallucinations.
- I understand that plant based medicine is not recommended in pregnancy or breastfeeding. If I become pregnant or start to breastfeed whilst on a plant based medicines, I agree to inform my clinical team and immediately stop the product.
- I understand that inhaling plant based medicines, even in a vaporiser, may lead to chronic lung conditions such as emphysema. We cannot guarantee that vaporising or inhaling plant based medicinal products is not carcinogenic as further research into this area is ongoing.
- I understand that an approval from the Therapeutic Goods Administration (TGA) Special Access Scheme may be required for plant based medicinal products before a plant based medicine prescription can be issued and that it is not guaranteed that my application will be approved for the use of plant based medicinal treatment.
- I understand that the Australian Government’s Therapeutic Goods Administration (TGA) does not guarantee quality, safety and efficacy of plant based medicine.
- I understand that it is an offence to drive in Australia or operate heavy machinery with any illicit or unlawful substance in my blood or saliva and if I drive I am breaking the law.
- I understand that a legally issued prescription is not protection against these laws.
- I acknowledge that if I experience a significant side effect I will stop the product immediately and seek medical attention. I agree to book a review consultation in this event.
- I accept Atlus does not provide emergency or GP care, nor replace my regular treating doctor. I am responsible for maintaining care with my regular treating practitioners.
- I agree to notify other prescribers that I am using plant based medicines and that Atlus cannot provide advice regarding modifications to existing medications.
- I agree to keep a log of my doses and changes in symptoms whilst on plant based medicines.
- I agree to arrange and attend regular follow up consultations as required. With the 1st review consultation to be held within 4-6 weeks of initial consultation and follow up review consultations to be arranged every 2-3 months from the previous review consultation.
- I acknowledge that if I have further queries or require additional clarification after my appointment I will contact the clinic to schedule a review consult.
- I understand clinical advice cannot be provided outside of a consult.
- I agree that I will not use any form of illicit or unlawful substance whilst on plant based medicines.
- I agree that I will not use any alcohol whilst taking plant based medicines.
- I consent to Atlus contacting other health providers to obtain verification and any relevant health information for the purposes of prescribing plant based medicine.
- I understand plant based medicine may interact with other medications and doses may require adjustment.
- I agree to notify Atlus of any changes to my current medications.
- I am aware that plant based medicines that can be vaporised will only be considered at the discretion of the doctor and may require a trial of other prescribed forms of plant based medicine (including but not limited to oils/tablets/wafers etc).
- I acknowledge that some plant based medicines are not recommended in under 18’s and therefore if I am under 18 years of age I will not be prescribed these types of plant based medicines under any circumstance.
- I agree to share my anonymised clinical outcomes for research purposes.
Terms & Conditions & Policy Acknowledgement
- I agree that by signing this form I acknowledge that I have read and fully understand the policies, guidelines and fee schedule of Atlus. I acknowledge that I have reviewed and confirm my consent to the requirements outlined in this document and that the information I have provided is correct to the best of my knowledge.