Orthopaedics 360
Before your first appointment with Dr Chien-Wen Liew, please complete this form. Have your Medicare card, private health card, and GP details ready.
This takes approximately 5–10 minutes. A summary will be emailed to you on completion. Your information is kept strictly confidential.
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Enter your name as it appears on your Medicare card.
Please enter your first and last name.
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Please select your date of birth.
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Please enter your mobile number and a valid email address.
Email addresses do not match.
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No PO Boxes please — we require a residential address.
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Your emergency contact details.
Please enter your next of kin name and phone number.
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Please enter your referring doctor's name and clinic.
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Please have your Medicare card handy.
Medicare number must be exactly 10 digits.
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Please select any that apply to you.
Select none if none apply.
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Please enter your weight and height.
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Please select a procedure.
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Please read the following carefully before proceeding.
Consultation fees
Initial Consult: $300 (Aged Pension: $200)
Review Consult: $140 (Aged Pension: $105)
A Medicare rebate is returned to patients with a valid Medicare card. The out-of-pocket gap varies depending on your Medicare and private health entitlements. Please ask reception for a detailed fee estimate at time of booking.
Surgery fees
Surgery fees are a set fee, with a rebate applicable from Medicare and your health fund. An email will be sent to you with the relevant item numbers so you can check your entitlements with your health fund prior to surgery.
Approximate surgical fee: $6,580 for a hip or knee replacement, prior to any rebates. The combined Medicare and health fund rebate is typically approximately $1,500.
Payment terms
Accounts are payable in full on the day of consultation and 5 days before surgery.
Please note that Medicare does not completely cover the cost of your consultation or surgery.
It is a term of the provision of these services that the patient shall be liable for all debt collection fees and charges, including but not limited to agent fees, solicitor costs and disbursements, in the event that collection is required.
Other fees
Additional fees may be incurred for medical forms including insurance, income protection, and similar documentation. Dr Liew does not undertake WorkCover or third-party work, second opinion consultations, or any surgery other than total hip replacements and total knee replacements.
Consent & disclosure
I understand that payment of the account is my full responsibility. I consent to the release and communication of information from and to any other medical provider for the purpose of my ongoing clinical management, and for ongoing clinical research, audit and education (including letters, images, and video). Clinical images may be used in a de-identified manner for marketing or educational purposes.
Dr Liew may at times have a financial interest in prosthesis or services, including Eastwood Private Hospital. This will not impact any clinical decision-making or recommendations given.
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By submitting this form, I consent to treatment and communication regarding my care from Dr Chien-Wen Liew and Orthopaedics 360.
I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that providing false or misleading information may affect my care.
I consent to my personal information being used for the purposes of my medical treatment and practice administration, in accordance with Australian Privacy Law.
You must agree to the terms to proceed.
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Please sign below using your finger or mouse to complete your intake form.
Please provide your signature.
Your intake form has been received. We will be in touch shortly to confirm your appointment details.
Orthopaedics 360 · Dr Chien-Wen Liew