Client Intake Form

Client Information

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Appointment Preferences

If you have a preferred day or time for an appointment please indicate below and we’ll do our best to accommodate you.

1. Payment Consent: By accessing our service you give consent to assessment and treatment with MLSP Speech Pathology and accept responsibility for payment of fees for services rendered by the practitioner. Payment for service is required at the end of each session for privately paying clients and self-managed NDIS clients. Invoices may be issued after treatment as necessary.
2. Cancellation Policy:
   

   a) If you are unable to attend a session, you must provide MLSP with 2 business days’ notice. If you fail to notify MLSP 2 business days before your scheduled appointment, MLSP may charge for the cancellation of the session.

   b) NDIS participants will be charged for cancellations per the current NDIS pricing arrangements.

3. Service Agreements: NDIS clients will be required to sign a service agreement with MLSP which details your responsibilities and MLSPs responsibilities and outlines proposed plan for our involvement and budget.
4. Confidentiality and Clinical Information Release: You authorize MLSP to communicate with the interdisciplinary professionals involved in your care, and to release any relevant clinical information to those professionals as appropriate.
5. To review our full Terms and Conditions click here.

By indicating your consent below you acknowledge and warrant that you have read and understood our terms and conditions and provide informed consent to commence treatment with MLSP Speech Pathology.