PATIENT CONSENT QUESTIONS

– I consent to MRI Now collecting my information and sending my referral to the radiology centre in order to arrange an appointment on my behalf.

– I consent to MRI Now obtaining a copy of my radiology report and providing a copy of my radiology report to my doctor, insurer, rehab provider, insurance broker and employer.

– I consent to MRI Now providing my details to a solicitor nominated on their behalf and at no cost to me, for the recovery of any outstanding fees to MRI Now in the event my insurer does not pay the full amount for the services arranged by MRI Now and which would result in me owing a gap payment to MRI Now.

– I confirm I have been informed I will not be required to pay any legal fees for the recovery of the gap payment because the solicitor will be paid a fee by the NSW Government for legal services in relation to the recovery of the gap payment. In the instance the solicitor is unsuccessful in challenging the non-payment of the gap fee, I will not need to pay that gap fee because I have done all I can in the circumstances.

– I understand that by agreeing to this authority:
1. I will not need to pay for the gap fee, win or lose;
2. MRI Now may be paid the gap fee;
3. The solicitor will be paid a legal fee for their recovery work, at no cost to the patient

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