Ph. 08 8215 0047



Twin Plaza Arcade
21 Hindmarsh Square, Adelaide

Consulting Hours

9.00am – 5.30pm
Monday to Friday

New Patient Form

Patients who are new to Performance Physiotherapy are required to complete a New Patient Form.

The Form can be completed prior to arriving at your first appointment. Alternatively, the form can be completed upon arrival to the Clinic.


Personal Details
  1. Salutation
  2. (required)
  3. (required)
  4. (required)
  5. (required)
  6. (valid email required)
  7. (required)
Private Health Insurance
General Practitioner Information (if known)
General Health
  1. Do you have a pacemaker?
  2. Are you pregnant?
  3. Are you currently taking any medication?
Emergency Contact
  1. (required)
  2. (required)
  3. (required)
  4. (required)
Workcover and Vehicle Accident Information (if applicable)
  1. Has your claim been accepted?
How did you hear about Performance Physiotherapy?
  1. How did you hear about Performance Physiotherapy?

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