Maxvale Physio Online REGISTRATION FORM (Chinese translation) Logo
Language
  • English (US)
  • Chinese
  • REGISTRATION FORM

    登记表格
  • Ph: 03 8759 1623  |  Fax: 03 9796 8034

    Web: https://www.maxvalephysio.com.au

    Email: maxvale.physio@gmail.com

  • Personal Details


  •  - -
  • Emergency Contact Details

    紧急联系人(名 / 手机号码)
  • How are you paying for your sessions?

    理疗付费方式

  • Claim details (if applicable)

    保险公司详细资料
  • Medical History Details

    病史

  • Screening Questions

    新冠病毒甄别问题
  • Browse Files
    Cancelof
  • How did you find us?

    您是怎么得知我们的?

  • TERMS & CONDITIONS

    接受理疗同意书

    Maxvale Physiotherapy – Physiotherapy, Pilates, Gym and Hydrotherapy (“Maxvale Physiotherapy”)

    Agreement of Release and Waiver of Liability

     

  • 我证明我接受理疗。

    我了解理疗或运动或水疗 的风险会因我个人别之情况而增加。

    我已尽我所知回答上述問題。如果我有任何身体状况或药物改变, 告知我的理疗师是我的責任。

    我了解遵守预约是我的责任。任何更改需要24小时的通知。我了解少过24小时的通知会有逾期取消费。

    1. Assumption of Risk

    1.1         I acknowledge that there are risks, dangers and hazards associated with exercise and in particular the practice of Pilates and / or Hydrotherapy.

    1.2         I accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, damage or loss resulting therefrom.

    1.3         I acknowledge that even with clear instructions, there is a possibility of personal injury associated with participating in the activities and treatments offered by Maxvale Physiotherapy.

    2. Release and Waiver

    2.1         I release, waive and discharge Maxvale Physiotherapy, its directors, employees and instructors (all of whom are collectively referred to as the “Releases”) from any and all liability for my personal injury, loss, property damage or expense arising out of or sustained in the course of my participation in the activities and treatments offered by Maxvale Physiotherapy both inside and outside all of the Maxvale Physiotherapy Clinics, Gym, Pilates and hydrotherapy premises including negligence on the part of the Releases to safeguard or protect me from the risks, dangers and hazards referred to above.

    2.2         I agree that Maxvale Physiotherapy is not liable or responsible for any damage to, loss or theft of any personal property that I bring into the premises.

    2.3         I confirm that I have fully disclosed to Maxvale Physiotherapy all my injuries and illnesses past and present. In addition, I agree to report any changes in my physical condition to Maxvale Physiotherapy immediately.

    3. Cancellation Policy

    3.1         I understand that Maxvale Physiotherapy has a 24–hour appointment cancellation policy and that a late fee will be charged for any cancellation made less than 24 hours prior to that session.

    3.2         Pre-purchased blocks of 10 Hydrotherapy classes will expire 12 months after the date of purchase. Classes are non-transferable and non-refundable.

    4. Acknowledgement of Understanding

    4.1         I have read this document carefully and I fully understand its contents and meaning. I recognise that by completing this document I am waiving certain legal rights, including the right to sue. I acknowledge that I am completing this document freely and voluntarily.

    4.2         I recognise that this Agreement and Release and Waiver is a legal contract and that it is intended to be as broad and inclusive as permitted by Australian Law.

    4.3         I understand that upon the signing of this form, I agree to offer my consent to receive treatment within this practice. My Physiotherapist will discuss the options that will benefit my condition. I have the right to a second opinion at any time. I give permission to the therapist to exchange information with my doctor and other medical specialist when necessary. I understand this information is confidential. I understand the appointment scheduling policy of the company.

  •  - -
  • Should be Empty: