New Patient Form

Please fill out this form as accurately as possible to help us with your care. If you are unsure about something please ask us.

* Payment is required at the time of consultation for all private patients (DVA and InjuryNet will be billed directly)

* 12 hours notice is required or a cancellation fee may apply

FEES: Initial Review
Private patients → $94.00 $84.00

Workcover/TAC will be directly billed with approved Claim and details
Veterans Affairs will be billed directly

Non-attendance: $45.00

I hereby give permission for the collection of information regarding my health from other practitioners that I have seen or are involved my care. I also give permission for the delivery of information from this consultation to other health practitioners involved in my care unless they are listed below.