Mediflora Consent Form

Please complete your Mediflora consent and medical intake forms atleast 6 hours before your initial consultation. If your forms are not completed in time, your appointment may be changed to a nurse-led initial review so we can gather the required information before you see a doctor. If a nurse-led review is not available, your appointment may need to be rescheduled to the following day. If you need assistance completing these forms, please contact our Patient Care Team at patientsupport@medifloraorganic.com.au or call +61 489 266 018.

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Name(Required)
DD slash MM slash YYYY
Booking, Communication, Privacy and Care Coordination Consent(Required)
Unapproved Natural Therapies & Acknowledgement Of Risks Consent(Required)
Prescribing, Follow Up & Regulatory Requirements Consent(Required)
Dosing, Safe Use, Storage, Travel and Driving Consent(Required)
Costs, Legal Responsibilities and Regulatory Compliance Consent(Required)
Data, Outcomes, and Research Consent(Required)
Reproductive Safety and Opiate Replacement Treatment Consent(Required)
Final informed consent(Required)
Clear Signature
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