• BODYFIX PHYSIOTHERAPY- EXERCISE PHYSIOLOGY

    BODYFIX PHYSIOTHERAPY- EXERCISE PHYSIOLOGY

  • THIRD PARTY & INSURANCE REFERRAL FORM

  • CLIENT INFORMATION

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  • REFERRAL INFORMATION

  • REFERRER INFORMATION

  • TERMS AND CONDITIONS

  • If an appointment must be changed, 24 hours' notice is required If less than 48 hours (1 hour consultation) and 24 hours (30 minutes consultation) notice is given for a cancellation or you fail to attend an appointment time, a cancellation fee of 100% will be charged Consideration will be given for unavoidable circumstances. I hereby have received consent from the participant to make this referral and provide Bodyfix with the client's personal and medical details Liability: Bodyfix Physiotherapy & Exercise Physiology accepts no responsibility for the treatment received Any professional liability is between the patient and the individual therapist. (All Bodyfix Physiotherapy & Exercise Physiology physiotherapists and exercise physiologists are insured through their respective insurance companies Bodyfix Physiotherapy & Exercise Physiology adopts assurance protocols in accordance with the clinical guidelines as are specified by the Australian Physiotherapy Association & ESSA.

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