School Visit Information Form - QANC QLD ADHD & NEUROSCIENCES CLINIC

School Visit Information for Parents

Thank you for booking a school visit for your child. Below is some information regarding this visit:

School visits are charged at $240p/h – including travel
24 hours notice is required to change or cancel a visit, otherwise a one hour fee will be charged
School visits are usually booked in the mornings (any time between 8:00am and 11:30am) unless another time is required and you have pre-arranged this
It is your responsibility to contact the school to make sure the visit time is suitable and the teachers are prepared – 8am appointments may not be suitable at some schools. There may be assemblies, break times and other events that need to be taken into account
It is recommended that you meet the attending Psychologist at the school on the day of the visit
The clinic will confirm appointments the day before (or Friday if the appointment is on a Monday) – the clinic will not be contacting the school to confirm appointment times
If contact with the school is required you are welcome to pass the clinic email onto the teacher/s and they can e-mail prior to the appointment (please ensure e-mail subject contains: Attention – Sarah Gurrin). It is often a good idea for the teacher to contact us with any concerns so that we can be prepared for the visit.
If more than an hour is required then the appropriate amount of time needs to be booked (please note this includes travel to and from the clinic to the school)
Reception will call you after the appointment to arrange payment over the phone
Please fill out the online form below or alternatively download the form below and return it to reception in person or via email:

School Visit Form

School Visit Child's Information
- Childs Name*
- Parents Name*
- Parents Phone Number
- Parents Email*
- School Name
- School Address*
- School Phone Number*
- Child's Grade
- Teachers Name
- Teachers Email
- Next
Fee Payments & Cancellations
- Cancellations
  - QANC adheres to a strict Cancellation Policy to minimise waiting times. Cancellations made on the same day as the appointment or non-attendance on the day will incur a cancellation fee of the full consultation cost.
  - This fee does not qualify for Medicare Rebate
- Fee Payments
  - Fee payment is required at the time of the consultation.
  - Payment methods include EFTPOS, credit card and cash.
  - A referral from a GP is valid for twelve months. A referral from a Specialist is valid for three months.
- In accordance with the Privacy Act (1988), all information collected in this practice is treated as "sensitive information". To protect your privacy, this practice operates in accordance with the Act.
  
  We use the information you provide to manage your health care. You can assist in maintaining the accuracy of your information by advising the practice of changes of address, phone number etc.
  
  Selected information may be disclosed to various other health services involved in providing you health care management, (e.g GPs and other health professionals).
- Privacy Policy*
  - I have read and accept the Privacy Policy.
- Consent*
  - I give consent to QANC to access/disclose my personal health information by obtaining, accessing and/or communicating with my referring doctor and current/past medical providers or relevant services for the purposes of diagnosis, treatment and optimising my medical management as deemed appropriate and in accordance with Ethical and Best Practice Guidelines.
- *
  - I agree to the terms of the above consent to access personal health data, cancellation policy, fees and payment policy
- Signature*
- CAPTCHA - Please enter the code in the image
- Date
  MM slash DD slash YYYY

Download PDF Form Here

School Visit Information for Parents

Thank you for booking a school visit for your child. Below is some information regarding this visit:

School Visit Form

School Visit Child's Information

Fee Payments & Cancellations