Securely Submit Your Registration Information Direct to Neurology Network Melbourne

SSL Encrypted Secure Connection

    Title/Salutation (required)

    Your Name (required)

    Date of Birth (required)

    Your Address (required)

    Your Postal Address if different (required)

    Your Email (required)

    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

    Health Care Card Number

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

    I have read and accept the privacy policy (required)

    I am happy for medical correspondence regarding my care to be transmitted via email (required)

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

    Secure Encryption

    Privacy Policy

    Click on this link to read and review our privacy policy

    Doctor’s Fee Statement

    Dr Matt Hughes

    Please Note: This practice does not Bulk Bill

    Fees for neuropsychological assessment are $310.00 per hour and are charged for assessment time and report preparation. There is no Medicare rebate for this service.

    Please enquire with your private health insurer regarding any rebate payable by them.  Payment of your account is expected at the time of your consultation.

    NB: Workcover/TAC accounts – it is the patient’s responsibility to supply written approval by a third party/insurer of acceptance of financial responsibility for their accounts.  Workcover/TAC patients will be held responsible for the account in the absence of approval and/or payment.

    TAC Patients – Pre approval is required from TAC for any accident prior to 14th February 2018

    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 $530 cancellation fee