• Gold Standard Physio

    Patient Registration Form
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  • Medical Details

  • Physical Details

  • Your Injury Presentation

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  • Consent and Signature

  • The information contained in this form is to the best of my knowledge complete and accurate.

    I hereby confirm my informed consent to treatment, online treatment and exercise prescription by a chartered physiotherapist.

    I understand that as part of my treatment, I will recieve certain communications via some or all of the following methods: phone, SMS, email and post. And that these modalities can be used for follow-up communications.

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