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Patient Consent Form

Please complete the following form prior to your psychiatric assessment at Living Well Psychiatry.

By submitting your consent below, you are agreeing for us to process your Medicare claim under item/s 291, 293 and/or 348 on your behalf, where applicable. You are also agreeing to adhere to our fee, cancellation and rescheduling policies.

Do you consent to our Terms and Conditions?

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No

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Contact Us

Phone:  (03) 7066 4636

Fax:  (03) 9960 6111

PO Box 5012 
Alphington VIC 3078

admin@livingwellpsychiatry.com.au

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