1)  I confirm that all my details provided to the practice are true and correct, and I will check my details on file annually and update accordingly if I’m aware of something changing.
2) I hereby acknowledge that Rockview Med’s Practice primary form of communication is Email, SMS, and Phone call; the Practice no longer posts invoices / statements – and all communication is noted on the system for record keeping purposes.
3) I further understand that if my details have changed and I have failed to inform the practice, and I do not receive my communication and/or communication is sent to the wrong contact details, I will not hold the practice liable in any manner, sense or form.
4) I confirm that I am aware of the Facility Fee charged, and agree to pay it, this is payable per person per consult, and it is not covered by medical aids – this admin fee covers communication between the practice and the medical aid pertaining to phone calls / emailing / authorizations / chronics etc.:                                                                       

5) I understand that if I request a prescription and Doctor writes one for me; I will be charged a script fee; and whether I collect that script or not, I will still be liable to settle the fee, as it was a service provided to me, at the time of request.

6) I am aware the Practice Rates may increase annually and are subject to change and/or fluctuate without notice.
7) I understand and agree that once my Medical Aid Benefits are depleted, I will pay the Practice Rates, and thus loose the benefit of my Medical Rates.

8) As a member of a Medical Aid; I undertake to ensure that all claims submitted electronically by the practice to my selected Medical Aid have been paid, and any balances not paid, I will settle immediately.
9) I also agree that it is my responsibility to follow up with my Medical Aid should I have any queries regarding payments or medical services rendered.
10) I further agree that by seeing the Doctor for a professional medical service, the agreement is between myself and the Doctor, and I remain liable for all outstanding funds until settled by the Medical Aid that I chose and belong to.
11) Private Patients take note that the Cash Consult Fee includes medication dispensed from our rooms; however, this is subject to stock availability. Injections and Procedures are over and above the Consultation fee.
12) Should a Private Patient require a Procedure, a price may be quoted however, this figure may change depending on what happens during the procedure.
13) I understand that overdue accounts past 60 days will mean I will lose the benefit of the medical aid rates been charged, and I will have to pay at the private practice rate on the day and settle my outstanding amount on file before been able to see the Doctor and/or before I leave. Only when my account is on a zero balance will I be afforded Medical Aid Rates.
14) We will not enter any discussion with medical aids regarding non-payment of member accounts. If it has been submitted, and rejected, the Patient is to settle the Doctor’s account, and sort out with their medical aid.
15) I understand that this is a C.O.D (Cash-on-Day) Practice, all amounts outstanding for both Medical Aid and Private Patients needs to be settled before I leave, payment may be made via cash, card or EFT; I further agree to send the practice a proof of payment on EFT payments.
16) The onus is on me to use my file number & surname as the payment reference when making payments electronically, the Practice will not be held liable for unallocated amounts due to the incorrect reference being used.
17) I understand that the practice does not offer an account facility, and any arrears need to be settled immediately, and that should I not comply that 2.4% interest will be charged on all outstanding amounts after 60 days, and every month thereafter.
18) Should a payment arrangement need to be made if I am unable to settle an account, a written agreement needs to be drawn up between myself and the Doctor indicating the terms, this will however only be considered in extreme circumstances.
19) Should an outstanding amount end up not been settled by 180 days, or I default on a written agreement. I acknowledge that the practice reserves the right to suspend my file for non-compliance to any of the above policy. The Practice reserves the right to hand-over my account, and I understand I will be liable for the costs incurred.
20) I as the Patient also dully understand that while every effort is made to avert any error, be they technical or human error, should any such error occur, the Practice will work towards rectification; however, the Practice, Doctors and/or Staff will not be held liable against any loss suffered by a Patient in such an event that an error cannot be rectified.
21) Should I at any stage decide to not use Dr. WL Oets Practice as my medical provider, I understand that my file is the property of the Practice, and that copies of my file can be made for me; but this will be done at an additional fee, normally charged for per page; and this excludes the medical notes as written by the Doctor; I am also aware that the Practice will only keep my file for six (6) years after the date of the last consultation before being archived and/or destroyed.