Book Online

Make an appointment with Dr Jessica below.

Important Notice: All payments are made in office following your appointment. Patients are responsible for claiming back from their medical aid afterwards.

Dr Jessica Leske

M. Tech Hom (UJ)

Practice number: 0625205

TERMS AND CONDITIONS BETWEEN THE PATIENT (INCLUDING PARENT/GUARDIAN, AS APPLICABLE) AND THE HOMEOPATH (DR J LESKE)

  • By booking with Dr Jessica, you agree to the terms and conditions outlined below.
  • Please reschedule the session if more than 15 minutes late.
  • 24-hour cancellation notice is required. 

PATIENT AGREEMENT

  1. The practice of Dr Jessica Leske is contracted out of medical aid. Invoices for consultations and medications are to be paid to the practice after the invoice has been issued and it is the responsibility of the patient to claim back from their medical aid. An invoice with all the necessary codes and information will be supplied to the patient to submit to their Medical Aid and to request reimbursement.
  2. I understand Dr J Leske’s legal duty and herewith consent to the disclosure of my diagnosis (ICD-10 codes) to the medical schemes for the purposes of reimbursement and/or settlement of my account. I further understand that this disclosure has consequences and same has been explained to me. I acknowledge that once my information has been sent to the relevant medical scheme, the registered homeopath (Dr J Leske) and staff employed by Dr J Leske have no further control over the management and utilization of the information and understand that the medical scheme will take responsibility for any further disclosure or utilization of such information for whatever purpose.
  3. I further understand and consent to the disclosure of my medical information to other registered healthcare professionals that I have seen and consented to receive my medical information. It has been explained to me that each member of staff has signed a confidentiality agreement which ensures that they are not able to disclose my personal and medical information to any third party, family member etc. of the respective employee. Dr J Leske will not disclose any personal and medical information to any of my friends or family members unless express consent is given by me, authorizing them to disclose certain information to same.
  4. Given that our aim is to provide you with ongoing treatment, we would like to use your information to keep you informed about our products and services which may be of particular interest to you, this may be through various channels including and not limited to WhatsApp, text messages, email communications, Facebook messages and posts as well as Instagram messages and posts. If you do not want to receive such information, you may opt out at any time. You may also give and withdraw consent and tell us what your communication preferences are.
  5. I hereby request and consent to homeopathic treatment (or on the patient named below, for whom I am legally responsible) by the homeopath Dr J Leske. I further understand that such homeopathic treatment may be performed by Dr J Leske now or in the future at this office.
  6. I am further aware and consent to that in order to proceed with an effective treatment, my health status must be evaluated by means of an interview and/or the performance of clinical tests. The reason for this is to not only diagnose my condition, but also to determine any contraindications that I may have to any recommended treatment. I am further aware of my right to have a person of my choosing present during certain physical examinations and it is my right not to remain disrobed any longer than is required for accomplishing such an examination. It is also my responsibility to disclose my medical information truthfully and accurately.
  7. I hereby consent to entering into consultation with Dr J Leske where:
  8. A full case taking history will be done with relevant questions asked.
  9. An Iridology photo to be taken and saved to Dr J Leske’s data cloud for future reference.
  10. Blood pressure, urine dipstick and a screening glucose test where applicable.
  11. Where applicable the administration of an intramuscular injection or a set of Biopuncture injections with Homeopathic formulation ampule preparations. Oral consent to be given and noted before any of the mentioned is administered.
  12. All of the above will be recorded in writing and kept in a patient file and stored accordingly.
  13. I understand that my homeopath will discuss the diagnosis, aim of treatment; benefits of treatment, common and specific complications and/or side effects of the treatment; treatment alternatives; potential results; and/or possible duration of treatment with me.
  14. I acknowledge that I have read this consent and I have discussed, or have been offered the opportunity to discuss, with my homeopath the nature and purpose of homeopathic treatment in general, the treatment options and recommendations for my condition, costs and the contents of this consent. I also understand that results are not guaranteed.
  15. I intend for this consent to apply to my present treatments and, in future, should it occur that my condition changes during the course of my treatment, I will participate in any decision affecting my personal health and course of treatment. I further note my right to withdraw my consent at any time for any specific procedure and/or treatment.
  16. I understand my homeopath’s legal duty and herewith consent to the disclosure of my diagnosis to the medical schemes, other medical professionals and support staff employed this practice for purposes of reimbursement and/or settlement of my account, administrative tasks and/or referral. I also hereby accept full financial responsibility for this account until it is settled in full. I confirm that all details provided are both true and correct.
  17. I further understand that access to the premises of the homeopath and the use of all facilities is done at my own risk. Neither the owner of the premises nor the homeopath who operates the business or their employees, agents or anyone temporarily in their service shall be liable for any damage, loss and/or injuries sustained as a result of such entry unto the premises and I hereby indemnify the owner of the premises, the homeopath and all employees in their service, agents and/or temporary workers against any liability for loss or damage of any kind whatsoever.
  18. It has been explained to me the costs involved in homeopathic treatment and I agree to said costs. I also understand that should I not cancel an appointment within four (4) hours of said appointment I may be invoiced for the full amount.
  19. Should I experience any side effects, I confirm that I will immediately notify my homeopath and inform her of same. My failure to raise any concern will create the assumption that I am satisfied with the service provided and further indicates that I am not experiencing any side effects to the treatment provided.
  20. I hereby authorize Dr J Leske to obtain copies of any past medical reports from previous physicians, special investigation reports and blood laboratory results on my behalf related to my current condition.
  21. I hereby consent to being contacted on the contact details as noted on my file by Dr J Leske for anything related to my medical history, treatment or administrative matters.
  22. For patients under the age of 18, a legal parent/guardian must consent to the above.