INJURY NOTIFICATION - PROHEALTH PHYSIO & FITNESS


At PROHEALTH PHYSIO & FITNESS, we provide friendly, personalised & caring service for clients from all backgrounds & personal circumstances. We are proudly different as our approach is to treat to a client's specific need rather than an expected repeat number of consultations. Our friendly team are committed to successfully helping our clients achieve sustainable recoveries & health goals. Our privately owned modern clinic is conveniently located in the heart of Lane Cove on Sydney's lower North Shore at 92A Longueville Road, Lane Cove, 2066.

Please complete your Injury Notification Form to all us to help you & meet our Professional Indemnity & Medical Malpractice insurance requirements.

If you have any questions, please call our friendly team on weekdays on (02) 8317-7770 or email us at [email protected].

On behalf of our PROHEALTH PHYSIO & FITNESS team, thank you for the opportunity to assist you.

Best wishes,

Julie & Marc

PROHEALTH PHYSIO & FITNESS Owners

WORK SMARTER > PLAY HARDER > LIVE BETTER!

PROHEALTH PHYSIO & FITNESS is an ABILITY GROUP specialist business

 Your Details
Lane Cove Football Club (LCFC)
Lane Cove Netball Club (LCNC)
FIT Lane Cove
Anytime Fitness
Vision PT
Soulful Fitness
Other
 Injury/Condition Details
Andrew
Marc
Julie
Other
Matthew
Chloe
Brian
Head (excludes face)
Face (excludes eye)
Neck
Thorax
Abdomen
Upper Back
Lower back
Pelvis
Upper arm
Elbow
Forearm
Wrist
Hand (include fingers)
Hip
Thigh
Knee
Lower leg
Ankle
Foot (include toes)
Unspecified bodily location
Shoulder
Eye
Multiple Injuries
Psychology
Other
N/A
Ambulance
Complimentary Screen
First Aid
Hospital
Medical Centre
N/A
Other

Declaration

INJURY NOTIFICATION DECLARATION & CONSENT


I understand the information contained in my Injury Notification Form is for record keeping purposes & to meet PROHEALTH PHYSIO & FITNESS insurance obligations.

I agree this Injury Notification Form is accurate at the time of completing & submitting this electronic form.

I acknowledge that in me, or a PROHEALTH PHYSIO & FITNESS staff member completing on my behalf, submitting this electronic form is equivalent to me physically signing a paper based form.

I understand a PROHEALTH PHYSIO & FITNESS staff member will contact following my injury/condition to understand how I am progressing & if I need further assistance.

Should I wish to obtain a copy of this electronic form, I can request a digital copy at any time via contacting PROHEALTH PHYSIO & FITNESS staff on (020 8317-7770).