For Nerva members in Australia
Print this template (or save it as a PDF) and take it to your GP or treating clinician. They complete the blanks and sign it, ideally on their own letterhead, and you attach it to your extras claim or coverage request.
The clinical details are for your clinician to complete. A letter in their words, under their signature, is what your fund wants to see.
Re: (DOB )
To whom it may concern,
The above patient is under my care for , a diagnosed condition.
As part of a structured plan for managing this diagnosed condition, I have recommended Nerva, a six-week health program for managing irritable bowel syndrome and other GI conditions, developed by Mindset Health. The patient completes the program at home, and it supports the self-management of their diagnosed condition alongside my ongoing care. The program costs AU$249/year, purchased directly by the patient.
I ask that you consider this program under the patient's extras cover or health-management benefits, and I am happy to provide further information on request.
Yours faithfully,
Signature:
Name:
Qualifications:
Provider number:
Practice & phone: