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Welcome to Healthemind Clinic!

We are pleased to welcome you to Healthemind Clinic and are delighted to have you join our team. We look forward to supporting you in establishing your consulting practice with us.

To ensure a seamless onboarding process, we kindly ask that you provide the following details at your earliest convenience:

Contact Information

Title *

First Name *

Last Name *

Mobile Number *

Postal Address *

Alternate Email Address

Software Information

At Healthemind Clinic, we utilise Bluechip, which is fully integrated with Medical Director, for all scheduling, patient records, invoicing, and billing processes. Comprehensive training and ongoing support will be provided to assist you in becoming familiar with the system.

Would you like to utilise BlueChip?

Yes No

If you would like to utilise your own software, please provide software details

Consulting Room Requirements

Preferred Consulting Days *

Preferred Consulting Hours *

Will you require administration support? *

Room Required *

Start Date

Professional Details

To facilitate your registration and billing setup please provide the following:

Provider Number *

Australian Business Number (ABN) *

Clinic Preferences

What conditions or areas of practice do you prefer to treat?

Do you have set appointment fees for different types of consultations (e.g., initial, review)?

Do you require any specific forms to be completed prior to seeing a patient? (For example: mental health screening tools like K10, ADHD forms such as ASRS, or a patient registration form.)

please provide a copy of the screening form(s) you currently use for patient assessments?”

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Do you wish to offer telehealth consultations?

YesNo

If yes, do you require prepayment for telehealth appointments?

YesNo

Bank Details

For processing invoice payments and EFTPOS settlements, please supply:

Name account is held under *

BSB *

Account Number *

Branch Location *

Bank Name *

Note: Payments will be processed via the clinic's EFTPOS terminal. If you prefer to use your own billing system or require a tailored arrangement, please advise so we can make appropriate accommodations.

Letterhead and Appointment Card Setup

To prepare your personalised clinical correspondence, invoicing, and receipting materials, please confirm how you would like your details to appear:

Full Name *

Qualifications *

The clinic’s standard contact details are listed below and will be included unless otherwise specified:

T: (02) 4956 0149
F: (02) 4956 0193
E: healthemind@aurorahealth.com.au
Address: Suite 5, Toronto Medical Centre II
239–241 Excelsior Parade, Toronto NSW 2283

Emergency Contact

Emergency Contact Name *

Phone Number *

Address *

Relationship *

Acknowledgements

Please be assured that all personal and financial information you provide will remain strictly confidential and will be used solely for administrative and payment-related purposes.

Should you have any questions or require further assistance, feel free to contact Renae Willis, Practice Manager� renae.willis@aurorahealth.com.au

We look forward to working with you