MEDICAL QUESTIONNAIRE
Medical History
To ensure optimal medical and surgical care, it is very important that you answer the following questions thoroughly and honestly.
To calculate your BMI please click here: BMI Calculator
BMI: Dr. Foti does not operate on patients who have a BMI over 30, due to the increased risk of post-op complications.
Please get in touch with us if this applies.
PHOTOGRAPHY CONSENT
Clinical photos may be taken at your consultation and will form part of your clinical record. Images will be accessible to our staff for clinical purposes. Photos are stored in a secure server, compliant with the Australian Privacy Principles.
Declaration: I grant permission for photographs of me to be used in the formats indicated above. I am at least 18 years of age, have read and understand the foregoing statement, have not been offered inducements to provide permission, and am competent to execute this agreement.
PRIVACY
Personal and Health Information Consent
We respect your right to privacy and take our privacy obligations seriously. We comply with the Australian Privacy Principles, found under the Privacy Act 1988 (Cth). Our Privacy Policy can be obtained by requesting a copy from reception or from our website.
We require your consent to collect personal information and health information about you. Please read this information carefully, and sign where indicated below.
We collect information from you for the primary purpose of providing you with our healthcare services. We require you to provide us with your personal and health information and your full medical history so that we may provide our services to you. We will also use the information you provide in the following ways:
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To appropriately manage our practice, including undergoing conduction audits and accreditation processes, managing billing and training staff.
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To effectively communicate with third parties, including Medicare Australia, private health insurers, government departments, and other practitioners involved in your healthcare.
During the post-operative period, if you have any post-operative complications, you may choose to send us questions or clinical photos for your nurse and Dr. Foti to review. In signing this form and choosing to transmit images or questions to us via email or mobile phone post-operatively, you acknowledge that these images may be transmitted to relevant clinicians via their devices (phones, iPad, email) for them to urgently review for post-surgical care as required.