I confirm that I have read and understood “What to Expect” and consent to being treated in the manner described.

I confirm that I am responsible for payment of fees. I understand I will be charged a $40.00 cancellation fee for Osteopathic or Massage Treatment if I fail to notify Hogan Osteo Plus within 24 hours that I cannot attend my appointment or fail to make my appointment.

I am aware that debt collection fees may be charged if I fail to pay my account in a timely manner.

If my practitioner becomes unavailable at short notice due to sickness or unforeseeable circumstances I am happy for my appointment to be rescheduled or to see another practitioner.

I understand that my personal medical information will be held confidentially at the premises of Hogan Osteo Plus. A report on my treatment, condition, progress, diagnosis may be forward to my General Practitioner, surgeon, ACC or other provider as requested. I consent to my NHI number being accessed for medical purposes so that investigation results can be electronically transmitted.