Patient Registration Details :

Do you have any type of physical injury or have you had a recent surgery (within last 12 months) or scar tissue?
Are you suffering from any of the following?
Females only :
Please tell us where you heard about us?
Have you received any vaccine within the last six months? (Please refrain for a minimum period of two weeks after receiving any vacination before coming into the clinic)
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Please select a convenient day for your appointment
Please select a convenient time slot (an initial consultation takes approximately one hour)
Would you prefer us to allocate an appointment for you? (You will be notified by email as soon as an appointment slot of your choice becomes available)
Which type of appointment would you prefer?

IMPORTANT - PLEASE READ

You are required to complete and submit the above information prior to booking your appointment.

 

 

 

We may require to contact you for further details