6 Frederick Road, Claremont, Cape Town 7708 info@homeopathycapetown.co.za 0216744476 benjamin_herr

Homeopathy Cape Town

New Patient

(All information supplied is treated as strictly confidential and is subject to the Protection of Personal Information Act 4 of 2013.)

Terms & Conditions

AGREEMENT IN TERMS OF SECTION 38A OF ACT 63 OF 1982

  1. I, the undersigned, do hereby agree to be treated by Dr Benjamin J. Herr, which treatment is to be based on Hahnemanian principles in relation to the practice of Homeopathy, plus/or any Dietary plus/or Nutritional supplementary treatment recommended by Dr Benjamin J. Herr together with their administration; orally, topically or by injection.
  2. I consent to the sharing of my personal information supplied above with Medical aid and other Healthcare providers.
  3. I further agree to pay all charges within 24 hours of consultation made by Dr Benjamin J. Herr at the following cash/credit/debit card only rates, free from any deductions or bank charges:
    1. R400.00 for a quarter hour or part thereof, and thereafter;
    1. R550.00 for every half hour or part thereof, and thereafter;
    1. R690.00 for every 3/4 hour or part thereof, and thereafter;
    1. R830.00 for every hour or part thereof, and thereafter;
    1. R195.00 for every additional quarter hour following the initial hour’s rate during the same consultation.
    1. (Please note that prices are subject to alteration without notice, after hours consultation and house calls incur additional fees and do not fall under this price structure.)
  4. ANY AMOUNTS NOT SETTLED WITHIN 24 HOURS ARE SUBJECT TO INTEREST CHARGES ARE BILLED AS SUCH.
  5. I acknowledge that any charges submitted to Medical aid are done so with my approval and are subject to my scheme rules. Any charges not settled in part of in full by my Medical aid are my liability and I agree to settle all outstanding amounts in full.
  6. I understand that any time spent by Dr Benjamin J. Herr analysing and/or cross referencing my case in order to prescribe/advise shall be charged at the above mentioned rates.
  7. I furthermore acknowledge that should I consult telephonically or electronically with Dr Benjamin J. Herr and/or accept instructions and/or scripts telephonically or electronically that he will under these circumstances charge for his time according to his going rate at that time.
  8. As to the charges for medicines, vitamins, supplements and consumables prescribed, dispensed and/or administered by Dr Benjamin J. Herr, I agree to pay to Dr Benjamin J. Herr the amount according to his working price lists within 24 hours of receipt of invoice, free from any deductions or bank charges, and any amounts not settled within 24 hours will be subject to interest charges and are billed as such.
  9. Appointments cancelled (or not kept) with less than 24 hours notice will be charged at R350 per occasion.
  10. I hereby agree to pay any/all legal costs incurred in the recovery of any unpaid invoices, together with interest arising therefrom.
  11. I acknowledge that this Agreement is binding on me, my heirs, executors, administrators or assigns and that these tariff charges supercede any prescribed Medial Aid or other tariff.
  12. While all prescribed measures are taken to prevent contact, transmisison and spread of COVID-19, I acknowledge that entering Dr Benjamin J. Herr’s practice in person poses a possible risk of exposure associated with COVID-19 and do so solely at my own risk.

VIDEO CONSULTATION INFORMATION AND CONSENT

A video consultation (Teleconsult) is the delivery of services using interactive video conferencing (Zoom,  Whatsapp  Video Call or FaceTime call or whichever electronic media is available and convenient to both parties which is closed for only this interaction (public social media not allowed)). The interactive electronic systems used in a video consultation are known to incorporate network and software security protocols to protect the confidentiality of information and audio/visual data. There is no subscription required when using the electronic platforms mentioned above, such as costs for the Applications (“Apps”) used, but I understand that I will carry my own costs of any infrastructure and/or running costs associated with such service being rendered e.g. the data used, the telephone and/or computer, etc. This enables Dr Herr at a distant location to provide a service. A video consultation will allow me to receive health care without the need to be in the same room as Dr Herr.

I understand that this consultation will not be the same as a direct patient visit.

I understand that I will be billed for a Tele consultation at the usual rate that would have applied for a face-to-face interaction. I acknowledge that I am aware that I can contact the practice to ascertain the specific fees. I understand that my medical scheme may, or may not cover the costs of this care.

I also understand that, due to the nature of the profession that Dr Herr may have to give urgent attention to other patients, and/or have to move my appointment to a later or earlier time or day.

I understand that Dr Herr is by law obliged to take notes during the session. For medicolegal reasons the session will may be recorded as a video for which I, the undersigned consent. I understand that Dr Herr will ensure the same privacy and confidentiality as during face-to-face consultations.

The service may have limitations relating to technology, such as data- and internet failures (e.g. dropped calls or bad reception). I understand that I am responsible for a secure and stable connection as far as possible. I understand that the laws that protect the privacy and confidentiality of medical information also apply to video consultations.

I have the right to withhold or withdraw my consent to the use of video consulting during the course of my care at any time. I understand that my withdrawal of consent will not affect any future care or treatment. I understand that Dr Herr has the right to withhold or withdraw consent for the use of video consulting during the course of my care at any time.

I understand that all rules and regulations which apply to the practice of homeopathic medicine in South Africa also apply to video consultations.

I will ensure a private space, without distractions and intrusions from others to engage in the consultation. I will inform Dr Herr if any other person can hear or see any part of our session before/during the session.

I have read and understand the information provided above regarding the video consultation.
I have discussed all of my questions and concerns with Dr Herr or receptionist and these have been answered to my satisfaction.

I hereby give my informed consent for the use of a video consultation in my medical care and authorize Dr Herr to use this in the course of my diagnosis and treatment.