New Patient

Costs of Recovery – The debtor/s shall pay for all costs actually incurred by Rutherford Doctors in the recovery of any monies owed under this Agreement including recovery agent costs, repossession costs, location search costs, process server costs and solicitor costs on a solicitor /client basis.

I understand that registering in MyMedicare is voluntary.

1. I consider this Practice to be my regular primary healthcare provider.

2. I consent to provide telehealth services (including long telehealth consultations).

3. I understand that I can only be registered with one Practice at a time. By submitting this form, any existing registration in MyMedicare will be withdrawn, and my previous Practice and provider will automatically be notified that I am no longer registered with them under MyMedicare.

4. I understand that I will remain registered unless:

● I register with a different Practice.

● I request my GP/Practice or Services Australia to withdraw my registration.

● My GP or Practice decides to withdraw my registration.

5. I understand that there is no cost to register in MyMedicare.

6. I declare I have read and understand the MyMedicare Privacy Notice and consent to my personal information being collected, used and disclosed by the relevant agencies such as Services Australia, the Department of Health and Aged Care, the Australian Digital Health Agency and, where applicable, the Department of Veterans’ Affairs as specified in the MyMedicare Privacy Notice (a link to this notice is provided in the Privacy Statement at the bottom of this form).

Privacy Statement: The law regulates how Services Australia, the Department of Health and Aged Care, the Australian Digital Health Agency and the Department of Veterans’ Affairs may handle your personal information. Services Australia is collecting your personal information to assess your eligibility for MyMedicare and provide services to you and payments linked to your provider as a result of your MyMedicare registration. Your information will only be shared with relevant government agencies such as the Department of Health and Aged Care, Australian Digital Health Agency and the Department of Veterans’ Affairs, where you have agreed, or where the law allows or requires it. The MyMedicare Privacy Notice describes how your information will be managed consistent with our obligations under the Privacy Act 1988 and the Australian Privacy Principles. The notice can be found at MyMedicare – PrivacyNotice

You can also read the:

● Services Australia privacy policy at: www.servicesaustralia.gov.au/privacy