The patient, more thoroughly described in paragraph 2, undertake to settle the account of the psychology practice of Gustaf Pretorius (hereafter referred to as “THE PRACTICE”) according to the tariff structure as determined by THE PRACTICE from time to time. All accounts will be settled within 30 days after the date indicated on the invoice. The interest on unpaid accounts will be 2% per 30 days. Should the patient neglect to settle the account and THE PRACTICE decided to take legal action, the patient will be held liable for the legals costs, costs for the collection of debts with respect to psychological services including attorneys fees on a solicitor own -client scale, commission, interest and finding costs.
The responsible person as defined in paragraph 1 above (from here onwards referred to as "RP"), binds her or him as surety and co-principal debtor, jointly and severally, with the patient for the proper fulfillment of the patient's obligations to THE PRACTICE in terms of this contract.
Both the patient and the RP confirm that all amounts payable to THE PRACTICE are due by themselves, apart from the failure of any medical scheme to pay any claim or any rejection of a claim by a medical scheme. THE PRACTICE may, but is not obligated, to submit claims on behalf of patients with any of selected medical aid to this, but are hereby pardoned from any damages that may result from administrative errors by THE PRACTICE.
The patient and RP agree that sometimes it may be necessary to give personal information to referring physicians, other interested professionals, hospitals and medical aids. Although I will do everything in my power to handle information with the utmost confidentiality, I can not be held liable for disclosure thereof by third parties. Any information that is disclosed, will be handled strictly according to the guidelines of the code of ethics of my profession.
The RP and the patient give permission to THE PRACTICE to share and exchange credit information with any credit bureau or other institution with whom they had or could have had financial transactions. Also if such information is requested under any circumstances as required in the National Credit Act 34 of 2005.
The RP and patient choose the physical addresses above as their domicilium citandi et executandi for the purposes of serving and undertake to inform the THE PRACTICE in writing of any change of residential address. The parties warrant that they have read and understood the terms and conditions of this contract, and that they consent to its inclusion in this contract.