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    Referring Doctor Address

    Name of GP (if different from referring doctor)

    Address or Suburb of GP (if different from referring doctor)

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    Is this referral related to a WorkCover or TAC claim? (required)

    If "Yes" what is the TAC/WorkCover Claim Number?

    Private Health Insurer

    Private Health Number

    Are you on a Full Pension?

    NoYes

    Are you on a Part Pension?

    NoYes

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    Privacy Policy

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    Doctor’s Fee Statement

    Dr Dinushi Weerasinghe

    Please Note: This practice does not Bulk Bill

    Consultation Item Numbers & Service Fees:

    Item 132: Complex Initial Consultation

    Standard Fee $600

    Medicare Rebate (approx) $250

    Item 110: Initial Consultation

    Standard Fee $450

    Medicare Rebate (approx) $143

    Item 133: Complex Review Consultation (20 mins)

    Standard Fee $310

    Medicare Rebate (approx) $125

    Item 116: Review Consultation

    Standard Fee $255

    Medicare Rebate (approx) $71

    Item 11018: Nerve Conduction Study/EMG (Simple)

    Standard Fee $545

    Medicare Rebate (approx) $208

    Item 11018: Nerve Conduction Study/EMG (Complex)

    Standard Fee $580

    Medicare Rebate (approx) $208

    Dr Dinushi Weerasinghe does not provide consulting services for WorkCover or TAC insured patients.

    Please note that these fees are reviewed on July 1st each year. Patients with financial difficulties should bring their circumstances to the attention of the staff or the doctor. Accounts referred to a collection agent or solicitor will have all legal costs and commission added to the amount due.

    **Please note, failure to attend without 24 hours notice may result in a $100 cancellation fee