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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

    Pension Number

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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 $575

    Medicare Rebate (approx) $240

    Item 110: Initial Consultation

    Standard Fee $420

    Medicare Rebate (approx) $137

    Item 133: Complex Review Consultation (20 mins)

    Standard Fee $295

    Medicare Rebate (approx) $120

    Item 116: Review Consultation

    Standard Fee $240

    Medicare Rebate (approx) $68

    Item 11018: Nerve Conduction Study/EMG (Simple)

    Standard Fee $520

    Medicare Rebate (approx) $200

    Item 11018: Nerve Conduction Study/EMG (Complex)

    Standard Fee $555

    Medicare Rebate (approx) $200

    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.