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Welcome. We want you to feel respected and safe.
City, town or suburb
Date of Birth
Phone (fixed line)
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Select any of the following that apply to today’s appointment
EPC - full payment is required and then we are happy to process your medicare rebate on the day of treatment
NDIS - you must supply a current NDIS Plan before your appointment.
Select all that apply.
Parent's Name (if coming for your child)
Other people involved in your care
please list all other relevant people involved in your care such as other medical/allied health provider, NDIS support coordinators and agency or personal trainer
What is the reason you have come to see us today?
Who suggested you attend Innerstrength physiotherapy?
You can select more than one.
Release of private health information.
I do not consent to sharing my personal information.
I consent to written and verbal communication with my GP.
I consent to written and verbal correspondence with my specialist/s.
I agree to pay the cancellation fee
Would you like to receive a free appointment reminder via SMS?
** Please note it is your responsibility to attend the appointment with or without the reminder.