Copyright 2019,. All rights reserved.

Balmain Sports Medicine is required to collect information from you for the sole purpose of providing quality treatment and healthcare. Our aim is to ensure that all information we hold is accurate, up-to-date and completely confidential.

All the personal information you provide is bound by our Private Policy Statement.

Be advised we use your preferred mobile number to confirm your scheduled appointment for the following day.

When completing your Patient Registration Form, we require that your practitioner is fully informed of all your medical issues that may affect the assessment and treatment of your injury. Please find below a ‘checklist’ to read prior to completing the Registration form:

• Do you have a pacemaker / hearing aid / metal implants / any other implanted device or prosthesis?

• Are you pregnant, or do you believe you may be pregnant, as this may affect the possible treatment options we can apply?

• Medication is an important factor we need to consider during an assessment and subsequent treatment program. Your current medications will need to be discussed with your practitioner. Please inform us if you have taken cortisone or other steroids at any time.

• Do you have any areas of abnormal skin sensation - e.g. numbness or tingling?


If you have any of the above, please ensure you alert your practitioner to these at the beginning of your appointment

Thank you for taking the time to read this checklist. We will use the information to ensure we are able to provide the best possible assessment and treatment for your injury.




Please bring along your own pillow & towel to your appointment. This is in accordance with our hygiene procedures in response to the COVID-19 Pandemic.

Your appointment will require you to be at Balmain Sports Medicine for approximately 1 hour following your scheduled appointment time (and maybe longer depending on your injury).

Please note we do have a 24 Hour Cancellation Policy that requires patients to provide at least 24 hours’ notice when cancelling or rescheduling an appointment. Late cancellations or failing to attend an appointment will result in normal consultation fees being charged.

You are required to pay all scheduled consultation fees immediately after you see the practitioner. All receipts of payment will be provided to you.

On the day of your scheduled appointment, we ask that you:

• Arrive 15 minutes prior to your scheduled appointment time to complete your ‘patient registration’ (read submitted form and sign consent), which is a medico-legal requirement prior to any treatment at Balmain Sports Medicine.

Bring your Doctor’s Referral (or other health practitioner)

Bring any Investigations ( XRay,  MRI,  CT,  ultrasound ) relating to your appointment for your practitioner to view.

Bring your Private Health Insurance and Medicare cards to enable you to claim your entitled and immediate rebate.

Wear Appropriate & Comfortable Clothing (shorts, T-shirts, training clothes) for your consultation. Your practitioner may require you to disrobe appropriately for the purpose of your assessment / treatment. If you forget, we will supply you with appropriate clothing.


New Patient Registration

For insurance claims, please answer the below questions. If not, skip to question 27

Please select all that apply