Contact Tracing & Consent Form

This information will be kept for contact tracing purposes and will be deleted after 30 days.

Your Full Name *required

Your Email

Your Mobile *required

Your informed consent is required for all treatments at our practice.
Please read the following and agree where indicated if you are agreeable.

Physiotherapy, Myotherapy & Remedial Massage involves the physical administration of a number of techniques. The therapists administering treatments are all appropriately qualified and covered by the appropriate insurances.

You have the right to withdraw your consent at any time, and treatment will cease. If you become uncomfortable at any time, or wish to discuss your treatment, you have the right to do so.

All forms of treatment carry some risks. These will be outlined to you, and you have the sole discretion of continuing or discontinuing treatment.

I give consent for treatment and agree to the risks and benefits outlined. This consent remains valid until such time as I withdraw it. I have read and fully understood the clinic Privacy Policy and Consent Policy

**I agree to the Terms and Conditions for treatment and attendance at Performance Medicine Pty Ltd* required
I would like to receive newsletters and emails about special offers from Performance Medicine in the future.**

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Ideally, please arrive 10 minutes prior to your appointment.

PLEASE NOTE we require 24 hours notice for any changes to your appointments, including rescheduling.

We hate to talk about fees, but if you fail to provide more than 24 hours notice, a fee of $55 will be charged to you (and we don’t want to do that!). Monday appointments need to be rescheduled by 12pm of the Saturday prior.

Good to know: we respect your privacy and will not sell, rent or share your personal information to anyone.

By clicking the ‘Book Appointment’ button; you agree that you have read and accept these terms.

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You will receive a confirmation email, shortly.

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Clinical Conditioning Classes are claimable on private health and are $51 per class. You also have the option to purchase a 5 pack which makes each class $49, or a 10 pack which makes each class $47.

Good to know: We respect your privacy and will not sell, rent or share your personal information to anyone.

By clicking the ‘Book Appointment’ button; you agree that you have read and accept these terms.

I agree to the terms

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Contact Tracing & Consent Form

You have the right to withdraw your consent at any time, and treatment will cease. If you become uncomfortable at any time, or wish to discuss your treatment, you have the right to do so.

All forms of treatment carry some risks. These will be outlined to you, and you have the sole discretion of continuing or discontinuing treatment.

I give consent for treatment and agree to the risks and benefits outlined. This consent remains valid until such time as I withdraw it. I have read and fully understood the clinic Privacy Policy and Consent Policy

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