Patient Registration Form


(If you have been referred by a friend/patient of the clinic. please provide us with their name so that we can thank them personally with a gift)


Is this a Workcover, CTP, Veteran Affairs or Chronic Disease Management claim?

*Please see reception on attendance - All necessary paperwork must be presented BEFORE your treatment

I request that the Headache, Neck & Jaw Clinic provides treatment or other services that I may require and I undertake to be responsible for fees payable.

I understand that the Headache, Neck & Jaw Clinic requires 24 hour notice for cancellation of appointments.  A cancellation fee of $60 will apply for late cancellations or missed appointments.

By clicking "Yes" means that you have read and agree to our payment policies.

Click on the year for more options

Once you have submitted your Patient Registration please wait to be redirected to our "Submission Successful" page to ensure its delivery to us

Physiotherapy for patients with Head, Neck & Jaw pain

Nundah \

Greenslopes \

Indooroopilly \

North Lakes \


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 07 3266 3389

Please be advised; all of our clinic phone lines are connected