Please submit this consent-form to ensure that you qualify for Bulk Billing your Telehealth Consultation

    Submission of this form constitutes consent that I agree to the assignment of the Medicare benefit directly to the provider for me, as described on this page and processed by Neurology Network Melbourne at the time of my telehealth appointment.

    Title/Salutation (required)

    Your Name (required)

    Date of Birth (required)

    Do you consent to have your telehealth consultation Billed to Medicare on your behalf?

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    Doctor’s Fee Statement

    For New Physician Telehealth Service Items the Australian Government has decreed that all consultation fees are to be Bulk Billed.
    Where additional administration support is required, for example delivery of scripts or production of reports an administration fee of a minimum of $10 + GST will be payable to NNM.


    Consultation Item Numbers & Service Fees:

    Item 91824: Bulk Billed New Patient

    Standard Fee $155.60

    Item 91825: Bulk Billed Review Consultation

    Standard Fee $77.90