To save time at your first appointment, please fill out our online patient registration form. If you have any questions, please contact our friendly administration team on 0410 559 856.
If applicable, please provide the following information:
I agree to pay all reasonable fees/charges incurred by the Vitalis Physiotherapy for goods and services provided for me including overdue account fees, booking fees and debt collection costs.
I authorise Vitalis Physiotherapy to disclose my personal information in relation to my health condition to any other health practitioner who is providing me with health care services or items.
I agree that in the event of non-payment of my account by my employer/insurer/DVA/Medicare that I will be held responsible for all reasonable fees/charges incurred by the Vitalis Physiotherapy for goods and services provided including overdue accounts fees and debt collection costs.
I authorise Vitalis Physiotherapy to disclose to my employer/employer’s insurance company, Work Cover Queensland, DVA and/or any other health practitioner who is providing me with health care services or items, any information in relation to my condition for which I have a claim.
In the event of the claim being rejected, the patient will be held responsible for all reasonable fees/charges incurred by Vitalis Physiotherapy for goods and services provided.
Physiotherapist in this practice will discuss your condition and options for treatment with you so that you are informed and can make decisions regarding your treatment. You may choose to consent or refuse any form of treatment for any reason including religious or personal grounds. Once you have given consent, you may withdraw that consent at any time.
Questions of a Personal Nature
Your Physiotherapist may ask personal questions relating to your injury and how your injury impacts on your ‘activities of daily living’. The more information you provide, the more likely it is that the physiotherapist can provide effective treatment. It is your choice as to what information you choose to provide.
During the examination, assessment and treatment it may be necessary for your physiotherapist to make physical contact. Your physiotherapist will ask your permission before making physical contact with you in any way. Physical contact requires your express consent. You may withdraw consent at any time at which point, all physical contact will cease immediately. Please inform your physiotherapist if you feel uncomfortable at any time.
Risk related to treatment
Physiotherapy is an effective and safe form of treatment. However, if there are any risks associated with the treatment, your therapist will clearly state them and discuss them with you.
Children, minors and Substituted Consent
Consent from a custodial parent is required to treat a minor. Where a person is incapable of understanding the risks and benefits of treatment, consent may be provided by another person legally authorized to provide such consent. Evidence of legal authorization is required in such circumstances.
You need to let us know when:- a pacemaker or heart condition- suffered from blood clots, thrombosis or stroke- suffer from diabetes- are currently taking regular medication
Your therapist will outline a treatment plan as the best plan for your recovery. You will achieve the maximum results when you follow your recommended treatment plan. To be consistent we ask that you schedule your appointments in advance.
WE HAVE 24 HOUR CANCELLATION POLICYFULL CONSULTATION FEE APPLIES FOR LATE CANCELLATIONS/NO SHOWS
The practice’s system will send you a reminder message the day before to the mobile phone that has been nominated.
24 hours notice is required to cancel or change appointments as we have a long waiting list. If you do not attend an appointment without giving us appropriate notice, full consultation fees will apply.
Consideration will be given for unavoidable circumstances. People who repeatedly miss or reschedule appointments will regretfully be discharged from care.
I have read and understood the above statements relating to consent for treatment. I offer my consent to receive treatment within the practice.
3/58 Oldfield Road, Sinnamon Park Qld 4073