Consent Form

To submit your Consent Form, please fill in your details below and click the Submit button.
Please note all fields are required & your details will be kept strictly confidential.


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Terms and conditions – Please read and confirm below:

PAYMENT in full will be made at the end of each treatment session. The clinic accepts cash, eftpos and credit card or you can make secure
payment via online services (enquire for account details). In the case where ACC funding is denied/declined I accept full responsibility for
funding of the physiotherapy services provided. ‘All costs incurred in the recovery of overdue funds including but not limited to debt
recovery charges and legal fees may be added to the balance of your account.’

CANCELLATION can be made with no charge if a minimum of 24 hours notice is given. Please note ACC does not cover cancellations, i’e.
failure to notify within this time will incur a full cost of the service booked (our surcharge and the ACC component). Cancellation fees will be
charged as follows: 1 hour session $60. 30 minute session $30.

CONSENT TO TREATMENT; STATEMENT:

I agree to give my consent to treatment from The Corrective Clinic as discussed by my therapist and reserve the right to refuse treatment at any time.