Dr Michelle Woolhouse Dr Kate Norris General Practitioner General Practitioner M.B.B.S F.R.A.C.G.P F.A.C.N.E.M Dr Jenni Koch General Practitioner M.B.B.S F.R.A.C.G.P Dr Cristina Cooper General Practitioner M.B.B.S F.R.A.C.G.P Irene Pilkington Welcome to Peninsula Holistic General Practice M.B.B.S F.R.A.C.G.P Dr Calan Khong General Practitioner M.B.B.S F.R.A.C.G.P Psychologist Grad Dip App Psych, BA Peninsula Holistic General Practice is a holistic medical centre established in 2009 by Dr Michelle Woolhouse which integrates western medicine with the treatments and philosophies of holistic and complementary therapies. We aim to be a medical centre where you feel cared for, listened to and appreciated. We hope to create a paradigm shift in thinking about health and well-being in an empowering way and giving you the tools, knowledge, encouragement and passion to make the changes towards a healthier you. Our Doctors aim to incorporate mental, physical, spiritual, emotional and environmental health with the intention of helping you to create optimal wellbeing. All our doctors, in additional to their medical degree and specialist qualifications in general practice, have post-graduate qualifications from the Australasian College of Nutritional and Environmental Medicine (ACNEM). For more information regarding our Doctors special interests please visit www.peninsulaholistic.com.au Our Doctors conduct their appointments in a relaxed and natural way, giving you time to express your concerns and consider the totality of the issues in your life with regards to your health. Our Doctors aim to provide to you with an appropriate and individual program so you can return to your desired state of heath. We do this by using a combination of diet, exercise, counseling, medicine, nutrients and herbs. Acupuncture and hypnotherapy and used where necessary. Irene Pilkington is our in-house Psychologist. Irene’s skills are in relationship, personal trauma, depression and anxiety counselling with special interests in Autism in children and adults, behavioural issues in children and teens, and providing support for their families. Emma Park is a Holistic Nutritionist, who holds a Bachelor of Health Science in Nutritional Medicine. Having graduated from the Endeavour College of Natural Medicine, Emma specialises in eating and exercise plans, weight loss, specific diets such as Coeliacs, FODMAP and the Paleo diet and she works to assist disease prevention. Emma also offers DNA testing to provide a blueprint for healthy aging and longevity. Please read information over the page regarding the clinic so we can best serve you in the future. Important Practice Information Cancellation / Confirmation Policy In order to respect each other’s time, we ask you to please make all efforts to confirm your appointment, particularly for your initial consultation. As a courtesy, we will send you a reminder about your appointment 24 hours prior, via SMS and/or telephone. If we cannot contact you for confirmation, your appointment will be cancelled. If you need to cancel your appointment, we require as much notice as possible. In the event of a late cancellation or failure to attend, you may incur a cancellation fee of 50% of your appointment cost. Follow-Up Results Policy It should not be assumed that this Practice will notify patients of all their test results. It is the responsibility of the patient to seek their test results and to book a follow-up appointment to receive and discuss pathology results. If however a result is abnormal, you will be contacted to arrange an appointment if we have not heard from you within a reasonable time. This holistic practice tends to focus on preventative and nutritional medicine and as such even normal results, when viewed in context, can tell the practitioner a great deal. Dispensary A small selection of therapeutic-dose, high quality ‘practitioner-only’ supplements and herbs are available from the Practice. You are under no obligation to purchase products from the dispensary which may be suggested by the doctor. Any profit received from the sale of these products goes towards the administration costs of running the dispensary. Please note this service is only available to active patients. Some supplements may be dangerous over a prolonged period if not monitored. Please ensure you follow the safety recommendations. If you have not seen a Doctor in 6 months regarding your current supplements, a follow up consultation is required. After hours / emergency call out Our doctors do not consult after hours nor do home visits due to family commitments. For Emergencies we advise you call 000 or go to Rosebud Hospital, phone 5986 0666. Additional charges This Practice charges $25.00 administration fee for the following: Replacement of lost/out of date prescriptions, pathology/xray referrals and specialist referrals (in the event that an appointment is not needed). Reports (ie insurance) and accessing of medical records will be charged privately and are time dependent. Centrelink forms will need a consultation. Feedback and Complaints If you would like to provide your opinion regarding our services, we value your feedback. Please drop us a line in our suggestion box, email or write us a letter. We endeavour to do our best by you. Privacy Policy All patient information is private and confidentiality is maintained at all times and the rights of every patient is respected. Patients have the right to access their own records. If you would like your records sent to another doctor a signed letter request must be sent from that doctor before a record is released. For further information please see our privacy policy or visit www.privacy.gov.au or Health Services Commissioner Tel: 8601-5200 Opening Hours Monday to Friday 9am - 5pm (closed weekends and public holidays) Dr Michelle Woolhouse Monday 9am – 5pm Wednesday 9am – 5pm Dr Cristina Cooper Tuesday 9am – 5pm Thursday 9am – 5pm Friday 9am – 5pm Dr Kate Norris Monday Wednesday Thursday Friday Dr Jenni Koch Tuesday Wednesday Friday 9am – 4pm 9am – 4pm 9am – 4pm Dr Calan Khong Tuesday Thursday 9am – 5pm 9am – 5pm 9am – 5pm 9am – 5pm 9am – 5pm 9am – 5pm Psychologist Irene Pilkington is available Mondays (fortnightly), Wednesday evenings, and Saturday mornings. FEE STRUCTURE Dr Michelle Woolhouse Dr Cristina Cooper and Dr Kate Norris Initial 1 hour Consultation: Item # 44 Cost $290 /270 conc. Medicare rebate $105.50 Item # 44 Cost $250 /$230 conc. Medicare rebate $105.50 Item # 44 Cost $220 /$200 conc. Medicare rebate $105.50 40 minutes Item # 44/199 Cost $190 /$180 conc. Medicare rebate $105.50 30 minutes Item # 36/197 Cost $145 /$135 conc. Medicare rebate $71.70 20 minutes Item # 36/197 Cost $125 /$115 conc. Medicare rebate $71.70 10 minutes Item # 23 Cost $75 /$65 conc. Medicare rebate $36.30 Acupuncture Item # 193 Cost $70 /$60 conc. Medicare rebate $36.30 Follow-up Consultations 60 minutes 50 minutes FEE STRUCTURE Dr Jenni Koch, and Dr Calan Khong Initial Consultation: 60 minutes item # 44 Cost $250 /230 conc. Medicare rebate $105.50 Follow-up Consultations 50 minutes Item # 44/199 $185 /$175 conc. Medicare rebate $105.50 40 minutes Item # 44/199 $175 /$165 conc. Medicare rebate $105.50 30 minutes Item # 36/197 $140 / $130 conc. Medicare rebate $71.70 20 minutes Item # 36/197 $120 /$110 conc. Medicare rebate $71.70 10 minutes Item # 23 $75 /$65 conc. Acupuncture Item # 193 $70 /$65 conc. Medicare rebate Medicare rebate $36.30 $36.30 Irene Pilkington, Psychologist One hour - $140.00 Concession rate is $120.00 with a current Mental Health Care Plan - Medicare rebate $84.80 ATAPS registered _________________________________________________________________________ Patient Information Surname ..............................................................................First name......................................................................................... Preferred name...........................................................................Title (Mr, Mrs, Ms, Miss, Oher).................................................. Date of birth..............................................Guardians name & DOB…............................................................................................ Address........................................................................................................................................................................................... ......................................................................................................................................................................................................... Mobile.....................................................................................Home phone...................................................................................... Email address................................................................................................................................................................................... Next of kin.................................................................................................... Mobile.......................................................................... Emergency contact person...........................................................................Mobile.......................................................................... Occupation (patient) …… ..................................................................................................................................................................... Medicare Number ................................................................Number next to yr name ...................Expiry Date.............................. □ Pension card □ HealthCare card □ DVA card Card number........................................................Expiry date................... How did you hear about us? ............................................................................................................................................ Are you of Aboriginal or Torres Strait Islander decent □ yes □ no I understand that notes, results, radiographs (xrays) and other models relating to my treatment may need to be sent to other medical practitioners to assist in my treatment and I consent to this. □ yes □ no I give my permission for the practice to use the above details to send me appointment reminders via SMS text message. □ yes □ no From time to time we up date you via email with regards to opening times, holidays, and other practice information via email. Are you happy to receive this via email? □ yes □ no I authorise Peninsula Holistic General Practice to forward and receive medical reports via fax or electronically (encrypted) on my behalf, if required. Patient Signature:.............................................................................................Date....................................... Your Health Information – Privacy Consent Form In accordance with the Victorian Health Records Act 2001 and Federal Privacy Act 1988 Our practice respects your right to privacy. We realize that it is important that you understand the purpose for which we collect details about your heath, as well as how this information is used at our practice and to whom this information might be disclosed. The policy of our practice is to follow these procedures: 1. The information collected will be used for the purpose of providing treatment to you. Personal information such as your name, address and health insurance details will be used for the purpose of addressing accounts to you, as well as processing payments and writing to you about our services and any issues affecting your treatment. 2. We may disclose your health information to other health care professionals, or require it from them if, in our judgment, that is necessary in the context of your treatment. In that event, disclosure of your personal details will be minimized wherever possible. 3. We may also use parts of your health information for research purposes, in study groups or at seminars as this may provide benefit to other patients, Should that happen, your personal identity will not be disclosed without your consent to do so 4. Your medical history, treatment records, x-rays and any other material relevant to you treatment will be kept here. You may inspect or request copies of our records of your own treatment at any time, or seek an explanation from the doctor. If you request an explanation of our records or a written summary, our usual fees apply to these services. 5. If any of the information about you is inaccurate, you may ask us to alter our records accordingly. 6. Your health insurance company may request information from your records which we are required to provide, subject to your consent. You can otherwise rest assured that your health information will be treated with the utmost confidentiality. Disclosure will not be made to any persons not involved in either your treatment or the administration of this practice, without your prior written consent. If you have any queries or concerns about our handling of your health information, please do not hesitate to raise these concerns with our practice. Patient Signature.................................................................................................Date................................... Our Aims Peninsula Holistic General Practice aims to be a medical centre where you feel cared for, listened to and appreciated. We hope to create a paradigm shift in thinking about health and well-being in an empowering way and giving you the tools, knowledge, encouragement and passion to make the changes towards a healthier you. We also aim to take care of the people involved in this practice. We believe that by looking after the staff and practitioners and encouraging self care and wellness within our practice, we will further benefit you as patients. Our Core Values We value our families and acknowledge how important they are to our well-being. We value our own health. We value each other and our impact on others. We value good medicine. We value our stories and our lessons and we value yours too. Our Mission To honour and care for our patients and ourselves. To deliver high quality General practice, incorporating age-old wisdom, modern research and open-mindedness.