Step 1 of 5 20% Name* First Middle Last Date of birth* Day Month Year Email Phone* Alternative phone (optional) Address* Street Address Suburb City Postal code I consent to examination and treatment which includes Acupuncture, Chinese Medicine and related treatments. I can participate in treatment planning and withdraw from treatment at any stage.* Agree Disagree My records may be made available to to other health professionals if it is considered to be in my interest.* Agree Disagree Wearing a face mask is optional, unless you're showing signs of respiratory symptoms.Should you experience any respiratory symptoms, such as a runny nose, sneezing, or a sore throat, or if you’re noticing signs typical of COVID, including a new cough, a loss of smell, or unexplained tiredness, we kindly ask that you take a Rapid Antigen Test (RAT) and let us know prior to your scheduled appointment. If you don’t have any of these symptoms, wearing a mask is optional! :) Agree Disagree Hiddenip address
