New Patient Registration Form

Heat Treatment:

When receiving heat treatment, all you should feel is a mild comfortable warmth. If you feel any more than this, you must notify the physiotherapist immediately as there is a possibility you may be burnt.

Assessment:

You will be asked to expose the injured area of your body so the physiotherapist can assess and treat you. Should you feel uncomfortable about this, please advise our staff as there are alternative methods available.

Please advise if you have any allergies to creams, tapes, or needles.

Acupuncture and Dry Needling: Potential Risks/Side Effects:

• Minor bleeding or bruising may occur in approx. 3% of treatments
• Symptoms may temporarily worsen after treatment, please advise your physiotherapist if this should occur
• Fainting or dizziness may occur, particularly with the first treatment
• Rarely may cause temporary local swelling
• Bodily infection or collapse of the lung in extremely rare cases (less than 1 in 70,000-1.28 million)
• Drowsiness may occur after treatment. If affected, you are advised NOT TO DRIVE or OPERATE HEAVY MACHINERY until symptoms have resolved.
• Your therapist will screen you for any reason why extra care is required or whether acupuncture/dry needling is an appropriate treatment for you.

Questions of a Personal Nature:

Your physiotherapist may ask personal questions relating to your injury and how your injury impacts your 'activities of daily living'. The more information you provide, the more likely it is that the physiotherapist can provide an effective treatment. It is your choice as to what information you choose to provide. If you feel uncomfortable with a particular question or group of questions, please let the physiotherapist know and they will cease.

Physical Contact:

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. Wherever possible, contact will be made using a towel or other forms of screening. 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.

Collection of Personal Information:

We require your consent to collect personal information about you. Please read the information below. By submitting this form, you agree to these terms.

Cancellation Policy:

Please notify us if you are unable to attend your appointment so we can arrange to care for another patient. We require 24 hrs notice either by phone/email/SMS or the full fee will be charged. If we are able to fill your appointment, there will be no charge.  

Privacy and Confidentiality:

At Sunshine Coast Health Services, we are committed to protecting your privacy. This Privacy Statement outlines how we collect, use, disclose, and protect your personal information in compliance with applicable privacy laws.

Collection of Personal Information:

We collect personal information from you to provide the best possible physiotherapy care. This may include your name, contact details, medical history, and other relevant health information.

Use of Personal Information:

The personal information you provide is used to:

• Assess your health condition and provide appropriate treatment.
• Communicate with you about your appointments and treatment plans.
• Collaborate with other healthcare providers involved in your care.
• Manage administrative and billing processes.

Disclosure of Personal Information:

Your personal information will only be disclosed to third parties with your consent or when required by law. This may include sharing information with other healthcare providers to ensure comprehensive care. We will not share your information for marketing purposes without your explicit consent.

Security of Personal Information:

We take all reasonable steps to protect your personal information from misuse, interference, loss, unauthorized access, modification, or disclosure. Your information is stored securely and only accessible by authorized personnel.

Patient Responsibility:

While we provide personalized treatment plans based on a thorough assessment of your condition, it is important that you do not share specific treatment advice with friends or family. Each individual's health needs are unique, and what may be appropriate for your condition may not be suitable for someone else. A complete assessment is required to determine the appropriate treatment for any individual who requires physiotherapy.

Questions and Complaints:

If you have any questions or concerns about our privacy practices, or if you believe that your privacy has been breached, please contact us. We will address your concerns promptly and professionally.

By submitting this form, you acknowledge that you have read and understood our Privacy Statement and consent to the collection, use, and disclosure of your personal information as described above.