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    Title/Salutation (required)

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    Mobile phone number (required)

    Home phone number (mobile preferred)

    Occupation

    Referring Doctor (required)

    Referring Doctor Address

    Name of GP (if different from referring doctor)

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

    Who is responsible for account payment?

    Medicare Number (required)

    Medicare Ref Number (required)

    Medicare Exp Date MM/YY (required)

    Are your bank details registered with Medicare?

    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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    I have read and accept the fee statement outlined on this page (required)

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    I will notify staff if correspondence regarding my personal and medical information should not be sent via email (required)

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    Privacy Policy

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    Doctor’s Fee Statement

    Dr Martin Short

    Please Note: This practice does not Bulk Bill

    Consultation Item Numbers & Service Fees:

    Item 132: Complex Initial Consultation (45 mins)

    Standard Fee $485

    Full Pension $465; Medicare Rebate (approx) $236

    Item 110: Initial Consultation

    Standard Fee $375

    Full Pension $365; Medicare Rebate (approx) $136

    Item 133: Complex Review Consultation (20 mins)

    Standard Fee $270

    Full Pension $200; Medicare Rebate (approx) $118

    Item 116: Review Consultation

    Standard Fee $200

    Full Pension $170; Medicare Rebate (approx) $67

    Dr Martin Short 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.