I have read the above information and understand the reasons Spark Health Co collect my personal information and how it is used. I know that it is my choice what information I provide. However, I also understand that withholding information may be detrimental to the assessment. I am aware that I can access and/or correct personal and assessment information on request. I understand I am financially responsible for any balance due on my account. I consent to the Physiotherapy assessment taking place in my home. I understand I can verbally withdraw consent at any time.

There is now a legal requirement that we gain your consent to collect and use personal information about you. Please read the following carefully and sign the declaration if you consent to Spark Health Co to collect this information. In order to perform the home assessment Spark Health Co needs to collect some personal and medical information from you. We may also use this information for: the administrative purposes of running the practice; billing, either directly or through a third party; disclosure of reports and medical information to you or other clinical treatment providers.

A fee of $350 is charged to my Home Care Package, which involves the Home Assessment, written report/recommendation and travel. Any extra report writing or assessing will incur an extra fee. Recommended equipment/supplies can be quoted and purchased separately to the above fee. Late cancellation of the assessment may incur a fee payable either by my Home Care Package or myself depending on my agreement with my provider.