News!Appointments available at Lara Physio from July 19th. Mondays 9am to 1pm.

New Patient Registration

New Patient Registration

Your details

If you have had investigations, Where were they taken? (N/A for none)
*NB - We use this to keep your GP up to date! (GP's appreciate our feedback and like to be kept up to date with their patients)

Parent or guardian details (if applicable)

Are you a pension/concession card holder? *
Which account type will you be paying with today?

Workcover details

TAC details

DVA Card *
How will you be paying today? *
Details of person responsible for payment of our invoices
Address
Address
Address line 1
Address line 2
City
State
Post code
Are you allergic to: *
*The main ingredients of the massage cream we use are: Arnica montana, Hypericum perforatum (St John’s Wort) Calendula officinalis and Melaleuca alternifolia (Tea Tree Oil)
Do you have a pacemaker? *
Do you have a history of fainting? *
Please discuss any concerns with your therapist before commencing treatment.
Checkboxes *

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