**Please bring your referral to your first appointment**
If I am unable to attend my appointment, I will give at least 12 hours notice of my cancellation.
Payment is due at the time of consultation.
I understand that if my account is overdue, I will be invoiced accordingly.
Any accounts which are not settled by the end of the month will incur an additional administration fee of $10 for every month overdue.
Any outstanding accounts requiring us to use a recovery agent will incur further additional processing charges.
To claim through workers compensation, we will need your employer’s details, insurance details and claim number (please see front of sheet).
Any missed appointment/s without cancelling may incur a charge of $35/$40 (depending on the physiotherapist).
Any information on this form will not be disclosed to any other parties.