(02) 8677 4062
Exclusive Wellbeing
Level 2, Suite 202
107 Phillip St
Parramatta NSW 2150
Exclusive Wellbeing Awakening The Field of Opportunity... Exclusive Wellbeing Choosing Your Path... Exclusive Wellbeing The Freedom to Leap Forward

Consent Forms

By law, all Consultants at Exclusive Wellbeing use consent forms that provide information regarding service provision, payment policies, and legal and ethical issues. This form must be agreed to and signed in order for us to work together. Do not sign the form until you feel comfortable with the information, and be sure to let us know of any questions you might have about it.

The consent form labelled “Consent to Release Information", allows Consultants at Exclusive Wellbeing to have contact with other professionals in order to provide you with the best possible continuity of care. If you would like us to talk to another doctor, therapist, school counsellor, etc., you will need complete this form.

Note:
Because of inconsistencies of various internet browsers in handling Fillable pdf Forms we suggest the following:
  • First download and save needed document (click the appropriate link with the right mouse button and then select “Save target as…” or “Save link as…” or similar…)
  • Open the document with Acrobat Reader
  • Fill in the form
  • Submit the Form to Exclusive Wellbeing by clicking “Submit” button
  • Print the filled form for your reference and signature
Medicare/Private Consent Forms

Consent FormConsent Form

Consent to Release InformationConsent to Release Information

Medicare/Private Consent Forms for Minors

Under 18 Consent Form (This form is for the Parent/Guardian to complete)Under 18 Consent Form (This form is for the Parent/Guardian to complete)

Under 18 Consent Form (child)  (This form is for the client under the age of 18 to complete)Under 18 Consent Form (child) (This form is for the client under the age of 18 to complete)

Insurance/Third Party Consent Forms Insurance Consent to Release Information Form

Insurance Consent FormInsurance Consent Form

Insurance Consent to Release Information FormInsurance Consent to Release Information Form

If you have any questions regarding these forms, please contact your therapist or Clinical Director (Dana Mitrovic) on (02) 8677 4062, who will happily explain these forms to you. Otherwise, you may wait to discuss this with your therapist on the day of your consultation.