As part of your confirmation for your first  consultation session, you’ll be asked to sign a form stating that you’ve read, understand and agree to the following terms and conditions. Non-active clients of more than 6 months, will be asked to sign a new declaration before their appointment to ensure they understand and agree to the terms and conditions that might have changed.

“new clients”:  Clients that has never been seen by Marise for medical/nutrition advice before, and those clients not seen in the past 18+ months.

“existing clients”: Those actively seen for the past 18 months

“online clients”: Clients buying on the online platform before or after seen for consultation by Marise for medical/nutritional advice.

LIABILITY FOR PAYMENT:

We do not submit to any medical Insurer and only accept CARD PAYMENT  OR EFT (Electronic Fund Transfer)

PAYMENT:
New clients: Full amount is due before your diet discussion.
Existing clients for follow-up appointments: EFT payments are due within 7 days of follow-up appointment, or before new diet plan are e-mailed.
Online clients: Upfront payment needed before diets plans are mailed.

All supplements will have to be paid in full at the time of collection.

I acknowledge that I shall be liable for:

• I undertake personal liability for all amounts payable to this practice in respect of services rendered to the patient as indicated on this patient information form.
• If ever, the practice submits a claim to the medical aid/ scheme, this will not in any way relieve me of my liability as aforesaid.
• Any bank charges levied against the practice in the event of a bank declining payment;
• Any legal costs incurred by the practice in recovering any amount due, calculated on the attorney and own client scale, including tracing fees and collection commission and administrative costs.

I acknowledge that in accordance with the provisions of Section 53(1) of the Health Professions Act of 1974 (duly amended) and section 6 (C) of the National Health Act 61 of 2003, the costs associated with all medical services rendered by the professionals are available to me, to the extend required in law and professional ethics, and that I am given opportunity to request more information and have done so before signing the declaration.

I undertake to notify the practice of any change in my indicated address or contact details.

I acknowledge that the fees charged by the practice may be different from the benefits to be paid by the medical aid / scheme, and I accept responsibility for full payment to the practice before claiming from my medical insurer.

I agree that in the event of any amounts owed to the practice are not paid on the due date, the practice shall be entitled to charge interest on the outstanding amount calculated as from the due date of payment at the maximum rate which may be legally charged.

MEDICAL SCHEME BENEFIT:

The practice doesn’t submit any accounts to the relevant medical aid / scheme for payment on behalf of the patient. It remains the patients’ responsibility to do so after the account is settled in full.

I understand that this practice may charge a different amount to that which might be covered by the specific medical plan and that it might not refunded the whole amount.

DISCLOSURE OF MEDICAL INFORMATION:

The practice is hereby authorized to disclose to the medical aid / scheme in relation to amounts payable to the practice, full details as to the nature, diagnosis, condition or treatment of the patient. Consent for discussion of patients with third party practitioners, will be needed to comply with current legal regulations.

There will be NO DISCLOSURE of genetic results to any other person than the named person on the report or the patients signed parent of guardian. Written consent will be needed for this via email.

The responsible person and/or patient has been informed that in certain circumstances, such as disclosure of ICD-10 codes, the exact consequences of disclosing such information to third parties are unknown to the practice and that information relating to these consequences must be obtained by a responsible person and/or person from the third party to whom the information is disclosed.

In the case of disclosing genetic results to third parties, via consent through the practice or directly from patients, the exact consequences to health through third party opinions or changes in this practice’s recommendations leading to ill-health are unknown to the practice and the practice can therefore take no responsibility.

Where the patient is a minor, is unmarried and below the age of 18 years, then the minor’s guardian(s) shall read this contract in their personal and representative capacities and in so doing accept inter alia responsibility for payment in full to the practice.

The patient, guardian and guarantor (as may be applicable) also agree that all patient records remain the property of the practice, and shall only be released on demand by an authorized person, with the discretion of the practice.

Please note that all medical files will be kept for 5 years after which it will be destroyed. Personal information and the patient’s file number will be kept on record for admin purposes.

GENETIC TESTING:

Prices for laboratory fees as well as the initial consultation needs to be settled via card after your sample collection appointment. (Please note that fees are payable in full before courier collection and lab testing.) Discussion sessions are charged per 30min – please enquire before-hand and settle the outstanding account via card after your appointment.

NON_GENETIC / HEALTH CONSULTATIONS AT THE PRACTICE:

Your initial appointment, diet calculation and discussion appointment sessions’ fees will be charged as a whole with EFT or card payment after your initial appointment. Only after settling your account will you receive a full statement with ICD-10 codes to submit to your medical aid for refund.

NON_GENETIC /HEALTH CONSULTATIONS VIA E-MAIL (ONLINE):

Your initial assessment will be via e-mailed questionnaire and possibly a phone call. Diets and meal plans will be calculated and your meal plan report with all relevant information and documents will be e-mailed to you. Discussion of meal plans are done via phone and is optional. You’ll receive a statement via email and need to settled your account via EFT before meal plans are mailed. 

POPI Act COMPLIENCE:

miDIET has to comply with the Protection of Personal Information (POPI) Act that came into effect on 1 July 2020. This act regulates how we use your personal information such as address, telephone numbers and e-mail address. We use your personal information to contact you regarding your appointments, your account, collections of supplements goods and for occasional emails regarding the practice and special offerings. We will never use your personal information for any reason other than within the normal scope of our practice. If you would prefer that we don’t contact you via electronic means, you can do so by advising us via written means for our records via email on accounts@midiet.co.za after your account is settled.

We generally store information about you for as long as we need the information for the purposes for which we collect and use it. Personal information and medical records for consultations are kept for 5 years as we are legally required to do so by the PHCSA. We will store other information for 2 years for tax and accounting purposes and website contact form entries for 6 months. This includes your name, email address and contact numbers.  You are welcome to contact us if you have specific concerns regarding our privacy policy.