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That I have been fully informed that Kearney Inc. does not charge any Medical Aid based benefits.
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That I am aware that Kearney Inc. fees are more than most Medical Aid Benefits.
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That I am aware that Kearney Inc. fees are based on the cost study performed by SADA and submitted to the Department of Health in 2009, the 2006 HPCSA fees, adjusted against inflation and the South African Dental Association D-Calc cost calculator. The Competition Commission declared Medical Price Fixing, by Medical Aids or Doctors, as illegal.
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That it is my obligation to request a full written cost estimate before commencement of my treatment;
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That no estimation will be given without x-rays and digital photo’s being taken of the patient.
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That I must personally consult with my medical insurer on their portion of payment on my cost estimate;
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That I accept full responsibility for my account to be settled directly after each visit. In the event that this account is handed over for collection I consent to legal fees on an attorney and client scale, collection commission, tracing fees and VAT (If applicable). Interest of 9% per annum will also be payable to Kearney Inc. Thirty day accounts will be handed over for collection;
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That I have the right to contact Dr. Kearney immediately if any dispute or complaint arises. In the event that a satisfactory solution can not be reached, the services of Dental Ombudsman is available. dentalmediator@sasa.co.za Tel: 011 484 5288
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That it is my responsibility to obtain authorisation from my Medical Aid for work to be done as well as hospitalisation if necessary.
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That an additional after-hour fee of R 3400 will be charged outside normal working hours – subject to annual fee changes;
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That in the event of a contractual dispute or any cause of action, ligation shall only be instituted in a court of the Republic of South Africa;
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That I selected the address below as my Domicilium Citandi et Executandi for all purposes under the agreement.
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That any registered notice which is forwarded to this address will be deemed to have been received three days after date of posting. I undertake to inform Kearney Inc. in writing by means of registered post one week in advance should this address change;
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That I consent to the taking of photographs and/or x-rays which might be used for teaching and informative purposes;
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That I accept one of the following payment methods: Credit Card, Debit Card, Cash, EFT(to be made IN practice)
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I give consent that Dr Kearney’s practice may contact me via sms or e-mail regarding the confirmation of my appointments, recalls and inform me of practice news.
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That I accept that a fee of R 2500 per half hour, or a portion there of, will be charged for all appointments not kept and not cancelled 24hours prior to my appointment– subject to annual fee changes.
