1. INFORMED CONSENT
1.1 Grant Mr. Johan Erasmus / Dr. Karlien Erasmus (“the therapist”) permission, during the course of psychotherapy with myself / the patient:
To utilize therapy and therapeutic techniques and to obtain information considered to be in the interest of the patient or his/her family, at the absolute discretion of the therapist.
1.2 I understand and accept that there is no guarantee that the treatment will be successful, or that the outcome will be exactly as expected. I understand that I have the right to terminate treatment whenever I wish to, should I feel that insufficient progress is being made.
1.3 I understand that the therapist may terminate the therapy should she feel that the patient is not co-operating.
1.4 I acknowledge that, should the outcome of therapy not be what I expected to be, I will not have legal cause of action against the therapist based on her professional and competent use of therapy or therapeutic technique, with the patient. I accept that this will also not provide grounds for refusal to pay the account or any portion thereof.
1.5 I give permission that relevant feedback can be sent to the referring doctor.
2.1 The fee for all services offered is charged at R1400.00 per 51 – 60 min session for 2023. This practice is contracted out and higher fees might occur for services delivered. For hospital visits and sessions scheduled not during normal office hours, an additional fee / 50 % modifier will be added.
2.2 In-person and online consultations:
- I understand and accept responsibility to settle the account immediately and in full, in cash or electronic payment directly after each consultation.
- The therapist is ethically bound by the same confidentiality laws for in-person as well as online consultations. The therapist will conduct online consultations in a closed and private room and I, as the patient, undertake to do the same. I acknowledge that online consultations are not allowed to be recorded or shared and that it is my responsibility to use a secured online platform for online consultations.
- It is my responsibility to claim from my Medical Aid Scheme (MAS) after the account is settled. I am aware that my MAS might not cover the full amount.
2.3 In-hospital consultations:
- Accounts will be submitted directly to the MAS, unless otherwise arranged.
- I understand that it remains my responsibility to confirm benefits for psychology from my MAS.
- In the event of MAS not paying for this service, paying only a part thereof or paying the amount into the patients account, I undertake to settle the account timely and in full, in cash or electronic payment.
2.4 I accept that the therapist is under no obligation to draw up reports of any nature relating to any service offered. Should the therapist undertake to draw up a report, the time spent drawing up the report will be charged for at double the hourly tariff for psychotherapy.
2.5 Compound interest at the prime bank rate may be levied on any account (or portion thereof) Outstanding for more than 90 days, until the date that the account is settled in full.
2.6 Tariffs may be adjusted from time to time at the discretion of the therapist, and if applicable, I agree to pay such adjusted tariffs in future.
2.7 It is acknowledged that, in accordance with the provisions of Section 53(1) of the Health Professions Act of 1974 (duly amended) and Sections 6(c) of the National Health Act 61 of 2003, the costs associated with all medical services rendered by the therapist, treatment and/or procedures have been discussed and were fully explained to the patient, to the extent required in law and professions ethics.
2.8 Appointments, which cannot be kept, must be cancelled at least 24 hours in advance and on a Friday before 12:00. Failure to do so will, WITHOUT EXCEPTION result in a full consultation being charged for. Please note that MAS might not cover such claims, in which case I ACCEPT PERSONAL LIABILITY FOR ANY SUCH CHARGES.
2.9 Should it be necessary to collect any monies from me in terms hereof, I accept responsibility for payment of all legal fees in connection therewith on scale as between attorney and own client, including any applicable costs such as tracing fees and collection commission.
2.10 In accordance with legal requirements the therapist is granted permission to disclose any information about patient including medical information and/or diagnosis or diagnostic codes, to relevant third parties (such as funders, administrators, switching companies, referral source and the like) for purposes of processing payments of accounts in respect of services rendered to the patient; as required by a specific Act or statute, professional ethics or formal policy of directive applicable to the situation. The patient have been informed that in certain circumstances, such as disclosure of ICD-10 codes, the exact consequences of disclosing such information is unknown to the therapist and that information relating to these consequences must be obtained by the patient from the third party to whom the information is disclosed.
2.11 The patient agrees that the therapist may: Make inquiries to confirm any information provided by the patient; Seek information from any credit bureau when assessing the patient’s application for credit, or at any time during his/her indebtedness to the therapist including tracing or confirming his/her whereabouts; Disclose the existence of his/her account to any credit bureau, sharing both positive or negative payment information about such account.
2.12 The patient furthermore agrees that the therapist will be entitled to obtain or disclose the above information: If the therapist considers it is necessary or may be of benefit to the patient; Where the therapist is under legal obligation to do so; Where it is in the therapist’s own or the public interest that she does so.