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    Referring Doctor

    Referring Doctor Address

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    Medicare Ref Number (required)

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    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?
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    Are you on a Part Pension?
    NoYes

    Pension Number

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    Privacy Policy

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    Doctor’s Fee Statement

    Dr Matt Hughes

    Please Note: This practice does not Bulk Bill

    Fees for neuropsychological assessment are $280.00 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.