Patient Information: 

To proceed with the telehealth appointment, we acknowledge the importance of safeguarding patient privacy and understanding how your information is handled. By submitting the information in this form: 

• I am aware that medicinal cannabis is an unregistered medicine in Australia, and its long-term side effects remain unknown. 

• I understand that driving with THC in my system is illegal in most Australian states and territories, and random roadside testing may detect it. A legally issued medical prescription does not protect me from prosecution under these laws. Hence, I must not drive or operate heavy machinery while using medicinal cannabis containing THC. Having a legally issued prescription does not provide a defence in such cases. 

• I am aware of the potential risks and complications associated with medicinal cannabis treatment. I agree to follow my doctor’s dosing recommendations and promptly report any adverse effects, such as changes in sedation levels, lethargy, fatigue, dry mouth, nausea, vomiting, diarrhea, drowsiness, dizziness, disorientation, agitation, balance problems, memory changes, paranoid delusions, or hallucinations. 

• I understand that medicinal cannabis may interact with my other medications, requiring adjustments as necessary. 

• I consent to attend regular follow-up consultations as directed by my doctor. 

• If I proceed with treatment, I agree to inform my prescribing doctor or Nurse Practitioner about my medicinal cannabis treatment. 

• I declare that all information provided in this Consent Form is accurate and true to the best of my knowledge and belief. 

Privacy and Terms 

Intake Form Submission: 

Before a patient’s appointment can begin, they are required to submit an Intake form. This form likely collects important information about the patient’s medical history, current health status, insurance coverage, and any relevant documentation. 

The intake form serves as a preliminary assessment tool. It helps the team at Aleafiate gather necessary information about the patient’s condition and determine whether the patient is eligible for the services offered. 

• I hereby consent and agree that if I do not submit the intake form in a timely manner, Aleafiate reserves the right not to proceed with the scheduled appointment. 

Aleafiate is committed to safeguarding the confidentiality of your personal information and health records. You can access our Privacy Policy on our website or request a copy. 

• I agree to Aleafiate’s handling of my personal information in accordance with their Privacy Policy. 

 

Medicinal Cannabis is a restricted S8 medication, and the Health Care Practitioner may need additional information before prescribing it as part of the TGA application process. This may include a Health Summary, Specialist Clearance Letter, or Pathology results. Failure to provide required paperwork may lead to appointment cancellation. 

• I understand The Practitioner may request additional supporting information for treatment purposes. Failure to provide this information may result in appointment cancellation. 

Aleafiate maintains a zero-tolerance policy towards verbal abuse directed at their staff and Doctors. Such behaviour, including swearing, or making unnecessary remarks, will not be tolerated. Abusive language affects the staff’s well-being, and any excessive or aggressive behaviour will result in the patient being asked to seek treatment elsewhere. 

• I acknowledge and agree with Aleafiate’s Zero-Tolerance policy. 

Please be aware that practitioners will call patient as close to their appointment time as possible. If a Patient need to reschedule, please provide 24 hours’ notice. His helps us make your time slot available to other patients who may be waiting for an appointment. 

• I agree with Aleafiate’s rescheduling policy. 

After the consultation, the clinic utilizes an efficient script delivery process to enhance patient experience and convenience. This involves sending the script directly to the patient’s preferred pharmacy and to the patient themselves via email along with the necessary Therapeutic Goods Administration (TGA) approval. 

To streamline the script delivery further and ensure patient safety, the clinic employs an advanced eScript software. This software can identify whether the patient has already been prescribed monitored medicines by another healthcare practitioner. If such matches are found based on specific criteria, the system can reject the script to prevent potential interactions or duplications. 

• I understand that if I have similar medication scripts from another health care practitioner, my new script may be rejected. In such cases, the consultation fee will be forfeited. 

Communication 

• I consent to receiving SMS appointment reminders, messages, and emails. 

Aleafiate Terms and Conditions 

• I agree to the updated Aleafiate Terms and Conditions. 

Aleafiate Privacy Policy 

• I agree to the updated Aleafiate Privacy Policy. Aleafiate may share patients’ private information with their third-party partner Hotdoc to facilitate telehealth appointments. 

Understanding and Consent for Telehealth Appointment 

About Medicinal Cannabis: As a patient participating in a telehealth appointment with Aleafiate, it’s important to be informed about medicinal cannabis: 

• Medicinal cannabis is not yet a registered medicine in Australia, and its long-term effects are still being studied. 

• Driving with THC in your system is illegal in most Australian states and territories. Even with a medical prescription, driving under the influence of THC remains illegal and can lead to legal consequences. 

• Understand the potential risks and side effects associated with medicinal cannabis treatment, such as changes in sedation, lethargy, dry mouth, nausea, dizziness, and more. 

• Medicinal cannabis might interact with other medications you are taking, requiring adjustments as advised by your doctor. 

Consent to Follow-Up: By proceeding with the treatment: 

• You consent to attending regular follow-up consultations as directed by your doctor. 

• You agree to keep your prescribing doctor or Nurse Practitioner informed about your medicinal cannabis treatment progress. 

Privacy and Terms: 

• You understand that submitting an eligibility form is required before your appointment begins. This form gathers important medical history and health status details. 

• Aleafiate ensures the confidentiality of your personal information and health records. Access Aleafiate’s Privacy Policy on their website or request a copy. 

Additional Information and Documentation: 

• Medicinal cannabis is a restricted S8 medication. The Health Care Practitioner might need additional information as part of the TGA application process for prescribing. 

• Understand that failure to provide necessary paperwork might lead to appointment cancellation. 

Zero-Tolerance Policy: 

• Aleafiate maintains a zero-tolerance policy towards verbal abuse directed at their staff or doctors. Abusive behaviour will not be tolerated and may result in seeking treatment elsewhere. 

Appointment Rescheduling and Fees: 

Practitioners will call you as close to your appointment time as possible. Please provide 24 hours’ notice to reschedule This helps us make your time slot available to other patients who may be waiting for an appointment. 

Script Delivery Process: 

• After the consultation, your prescription will be sent directly to your preferred pharmacy and to you via email, including TGA approval. 

• To ensure patient safety, an advanced e-Script software may reject the prescription if similar medications are prescribed by another practitioner. 

Communication: 

• You consent to receiving SMS appointment reminders, messages, and emails. 

Aleafiate Terms and Conditions: 

• You agree to the updated Aleafiate Terms and Conditions. 

Aleafiate Privacy Policy: 

• You agree to the updated Aleafiate Privacy Policy, including possible sharing of private information with third-party partner Hotdoc for telehealth appointments.