dr chryssidis patient contact details form

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Dr Chryssidis Patient Contact Details Form

Our records are entirely confidential.

Consent to Email
Pension Card Type
Will this consultation be a WorkCover OR Motor Accident claim?

Please note thatif your claim has not been approved you will need to pay for your consult onthe day and seek reimbursement.

There may be an“out of pocket expense”. please turn over …..

PAYMENT ISREQUESTED AT TIME OF SERVICE. WE ACCEPT CASH, CREDIT

CARDS AND EFTPOS!

A 24 HOURCANCELLATION NOTICE IS REQUIRED IF YOU’RE NOT ABLE TO

ATTEND THESESSION TIME OTHERWISE A PAYMENT IS REQUIRED FOR

THE SESSION NOTATTENDED. THIS WILL ENABLE OTHER CLIENTS TO USE

THE ALLOTTEDTIME. IF RUNNING LATE FOR YOUR APPOINTMENT, THE

SESSION WILL BESHORTENED SO THAT THE NEXT CLIENT IS NOT

INCONVENIENCED.

PLEASE CHECK THEBOX TO ACKNOWLEDGE AND ACCEPT

RESPONSIBILITYFOR PAYMENT OF ALL SESSIONS.


I consent toSmart Health Training & Services obtaining and giving

information, bothverbally and in writing, to/from other Health Professionals

pertaining to themedical conditions, where relevant, to the treatment being

received at SmartHealth Training & Services. These professionals may

include your GP,Case Manager, Radiologist. Etc

InformationConsent *select one

I consent
Do you wish to receive news from Smart Health training by email.
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Contact Us Today

Your time is always respected. You’ll never feel rushed and have all your questions answered. Contact us today to schedule your first appointment!

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