By accessing or using www.genoldfieldphysio.com in any way, including but not limited to, visiting or browsing the site or submitting an online booking, you agree to be bound by these terms and conditions. If you do not agree to these terms and conditions or any changes made to these terms and conditions, do not use, access or continue to access this site immediately. If you have any questions about this agreement, please contact us.

Please be aware that you will be required to sign an informed consent form at your first treatment at Genevieve Oldfield Physiotherapy. Please regularly review these terms and conditions for changes.

Genevieve Oldfield is a registered physiotherapist with the Health Professionals Council of South Africa (PT0113220) as well as the South African Society of Physiotherapy. As a result, she will endevour to abide by their ethical and professional codes of conduct.

I, the undersigned, hereby agree to the following:

Liability for payment

• I undertake personal liability for all the amounts payable to the practice in respect of services rendered to the patients as indicated on the online patient information form.
• I acknowledge that the practice will not submit my claim to a medical aid scheme and that I am personally liable for the amount due. I further acknowledge the practice will provide me (via email) with the relevant codes and information for me to claim back from my medical aid scheme.
• I understand that it is my responsibility to settle the payable amount due on the day of treatment (card facilities are available).
• I acknowledge that I shall be liable for any bank charges levied against the practice in the event of a bank declining to honour any method of payment made by myself.
• I acknowledge that I shall be liable for all legal costs incurred by the practice in recovering any amount due, calculated on the attorney and own client scale, including tracing fees and collection commission and administrative costs.
• I acknowledge that in accordance with the provisions of Section 53(1) of the Health Professions Act of 1974 (duly amended) and section 6 (C) of the national Health Act 61 of 2003, the costs associated with all the medical services rendered by professionals have been discussed and fully explained to me, to the extent required in law and professional ethics, and that I am given opportunity to request more information.
• I undertake to notify the practice of any changes of my indicated address, contact details or medical aid/scheme details.
• I agree on the amount payable to the practice in respect of services rendered to the patient shall be calculated on the basis of fees, rates and charges as may be imposed by the practice from time to time.
• I acknowledge that the fees charged by the practice may be different from the benefit to be paid by my medical aid/scheme, and I accept responsibility for any co-payment resulting from the difference between these two amounts.
• I agree that in the event of any amount owed to the practice that are not paid on the due date, the practice shall be entitled to charge interest on the outstanding amount calculated as from the due date to date of payment at the maximum rate which may be legally charged.
• I acknowledge that any after hour or emergency fee may be applicable after hours or in case of emergencies.
• I acknowledge that Genevieve Oldfield Physiotherapy has a 24-hour cancellation policy and that I will be liable for the full amount of the booked appointment if I miss my appointment or cancel within 24 hours.

Medical Scheme Benefit

• I acknowledge that pre-authorisation for treatment/services do not guarantee payment by medical aid/scheme, and that it remains my responsibility to obtain such authorisation if required by my medical aid/scheme.
• I acknowledge that if the practice is not a network doctor as indicated by my medical aid, that I will be liable for all costs pertaining to treatment.
• I acknowledge that it’s my responsibility to be informed of what level the planned treatment will be covered by my medical aid/scheme.
• I acknowledge and understand the payment options and policies of the practice.

Disclosure of Medical Information

• I acknowledget that all online booking information remains confidential and remains unshared, except for in extraneous circumstances. Information regarding my condition, diagnosis and treatment may need to be shared with other health professionals, medical aid/scheme and in the case of minors with parents. This will only be done with my express written consent.
• The practice is hereby authorized to disclose to the medical aid/scheme (if requested), or the Compensation Commissioner, Road Accident Fund or Insurer to whom the claim is submitted in relation to amount payable to the practice, full details as to the nature, diagnosis, condition or treatment of the patient.
• The responsible person and/or patient has been informed that in certain circumstances, such as disclosure of ICD-10 codes, the exact consequences of disclosing such information are unknown to the practice and that information relating to these consequences must be obtained by a responsible person and/or patient from the third party to whom information is disclosed.

Exclusion of Liability

• The practice and its employees shall not be liable for, and I hereby indemnify the practice and its employees, from all liability for any loss, injury and/or damage of whatsoever nature suffered by whomever, including but not limited to, loss or damage (direct, indirect or inconsequential), any injury (including fatal), sustained by and/or harm caused to the patient or any disease (including terminal), contracted by the patient, whatever the cause may be, whilst receiving the treatment or any other services, whether arising, either directly or indirectly, out of any omission, delict of contract by the practice or its employees.

South African Jurisdiction and Law

• The patient, guardian and guarantor (as may be applicable) consent and submit to the exclusive jurisdiction of the appropriate Magistrate’s or High Court of South Africa in respect of any dispute, which arises from or is in any way connected with the terms and conditions of treatment/services rendered, and agree that disputes of whatever nature will be subject to and governed exclusively by the laws of the Republic of South Africa, and the appropriate court of South Africa.

Minor patients and warranty of authority and indemnity

• Where the patient is a minor, is unmarried and below the age of 18 years, then the minor’s guardian(s) shall sign this contract in their personal and representative capacities and in so doing accept inter alia responsibility for payment in full to the practice and warrant their authority to waive the minor’s rights and agree to the disclaimer and indemnity as contained herein, and indemnify the practice and associated company, their directors and employees in respect of any damages, which arise from a breach of this warranty of authority.

General

• The patient, guardian and guarantor (as may be applicable) choose as my domicilium citandi et executandi the residential address recorded above the heading “Patient Information”.
• I agree that all patient records remain the property of the practice, and shall only be released on demand by an authorised person, with the discretion of the practice.
• I agree that if any provision of this agreement should be/become invalid, unenforceable, defective or illegal for any reason whatsoever, then that provision shall be deemed severable from the remaining provisions of this agreement, which shall continue in full force and effect.
• I acknowledge that Genevieve Oldfield Physiotherapy has the right at their discretion to amend these terms and conditions by posting the updated terms on their website. Your continued use of the website and booking system after such changes constitutes your acceptance of the new terms and and conditions.

Warranty of authority and indemnity

• The signatory (other than the guardian or guarantor) warrants, that where the signatory is not the patient, the signatory has the authority to contract on behalf of the patient and act as the patient’s agent in all respects, including the authority to waive the patient’s rights and agree to the disclaimers and indemnities in the respects set out in the contract.

Terms of this contract read, understood and agreed

• The signatory warrants that the signatory has read, understood and agreed to the terms and conditions set out herein including the disclaimer of liability and indemnities and contracts on such terms and conditions.
• I understand that I am entitled to obtain a copy of this document.

Date created: 29 July 2019