Patient Application and Consent Form

Medicinal Cannabis Eligibility

There is no predetermined list of conditions for which a cannabis medicine can be prescribed. Some conditions for which patients have been approved to access medicinal cannabis include chronic pain, anxiety, neuropathic pain, fibromyalgia, Irritable Bowel Syndrome, Palliative Care, Adjunct treatment to some cancer treatments, Multiple Sclerosis, Parkinson’s Disease, Epilepsy and a number of others.

Patients are advised that booking a consultation with a Doctor or talking to one of our nurses does not guarantee access to medicinal cannabis. Each Patient is different, and the doctor will undertake a full history and review your past and current treatments to determine if this therapy is right for you. If deemed appropriate, the Doctor will then apply for relevant state and federal approvals so a prescription can be issued. Patients are able to access medicinal cannabis products in Australia only after such approvals have been received.

Access to your Health Data, Privacy Policy & Use of email

Please be aware that we will need to collect and store information on your medical history and condition.

As part of the application process for accessing medicinal cannabis, we may also need to contact your other treating doctors to discuss your medical history and / or retrieve your records from them. The circumstances in which we will collect, use, and store your personal information are detailed in our privacy policy. By using our services you agree to our privacy policy.

Please note by using email to communicate with us then acknowledge that email and the internet is not considered a secure means of transmitting personally sensitive information and Honeypot general practice medical centre cannot guarantee the security of personal information transmitted by email and does not take any responsibility for any privacy breaches resulting from the use of email to transmit your personal information.

Safety, driving and operating machinery

Patients receiving cannabinoid medication should not drive, work at heights, operate heavy machinery, or work in situations where intact reaction times are critical for safety while under the influence of medicinal cannabis. For further information regarding the effects of medicinal cannabis, please contact your doctor.

Patients should be aware that it may be a criminal offence to drive while medicinal cannabis is detectable in their system. Patients should seek their own advice in this regard.

Patients accessing medicinal cannabis should seek their doctor’s advice before consuming medicinal cannabis in conjunction with any other medication or substance.

Most cannabinoid medications are not currently registered by the Therapeutic Goods Administration of Australia and are only available on a case-by-case basis under the Special Access Scheme. This means that unregistered cannabinoid medications have not been evaluated by the Therapeutic Goods Administration or approved through formal clinical trials and are still considered untested.

Medicinal cannabis treatments are experimental medications in Australia and are expected to have varying efficacy and (known and unknown) potential side effects. Patients undergoing this treatment acknowledge that Honeypot general practice medical centre is not responsible and/or liable for efficacy and/or the potential effect(s) (including side effects, or lack of effects) of these medications, that are unique for each patient.

Prescribed medicinal cannabis medications are regulated medicines that free from contaminants, such as heavy metals, parasites and pesticides through rigid third party testing.

Honeypot general practice medical centre is unable to facilitate a refund for the medical consultation after a Doctor appointment has occurred, or when cancellation requests are 24 hours prior to this consultation. Once Honeypot general practice has dispatched the medication a refund for this order cannot be processed.

Informed financial consent

Fees taken by Honeypot general practice medical centre are for the cost of the medical consultation. Further costs may relate to processing, and dispatching of medication, in addition to further clinical consultations. Patients will have been notified of any upfront costs prior to the service and may choose to opt out of this service. Please be aware that these consultations and services are not subject to a Medicare rebate . Honeypot general practice medical centre will be able to claim back any costs from a private healthcare service provider.

Scope of services provided

Honeypot general practice medical centre doctors have experience and further training in prescribing and monitoring therapies using medicinal cannabis. Honeypot general practice medical centre Clinic will work in conjunction with your general practitioner, specialist and other health practitioners but is not a replacement for those services. Patients must obtain their own medical advice in relation to the management of their condition.

Patient Conduct

This code outlines the expected standard of behaviour for all patients. By attending our private practice, you are agreeing to uphold this standard and failure to comply may result in immediate discontinuation of treatment.

I agree to not act in a manner others may find threatening, bullying, or frightening. Our practice has a duty to provide a safe physical and psychological environment free from aggression, abuse, intimidation, or racism for both staff and other patients.

I acknowledge by attending this private practice I am agreeing to abide by the practice policies and any conditions of entry. If these do not suit me, I will find alternative health care in Australia.

I acknowledge by attending this private practice I am agreeing to abide by the practice policies and any conditions of entry. If these do not suit me, I will find alternative health care in Australia.

I agree the GP may need me to return if my appointment length is not sufficient for multiple problems. I accept any appointment times offered to me are what is available.

I agree to not act in a manner which could harm others or myself and I understand I can approach staff if I am feeling distressed or anxious.

I agree to follow the direction of health service staff, which may include being asked to abide by government directives or our conditions of entry.

I agree the practice may have fees for services which I receive and payment may be expected on the day.

I understand running behind is sometimes out of the GP’s control as they may have unexpected, complicated consultations which run over-time.

I agree to cancel appointments I cannot attend with as much notice as possible. This will allow other waiting patients to receive medical treatment. I understand that if I consistently fail to attend appointments which I have made, I may be asked to seek healthcare elsewhere.

In return our practice will treat each patient with respect and professionalism.

I have read and understand the following information and accept the above restrictions whilst I am taking cannabinoid medications. I consent to my treating doctor working with Honeypot general practice medical centre to apply for the necessary approvals should the doctor determine that it is clinically appropriate to enable me to access medical cannabis.

I agree to the Honeypot general practice privacy policy and trading Terms and Conditions.