New Clients

Client registration form

Inspire Clinic is based in Rockhampton QLD, 4700. To prepare for your upcoming appointment, please complete all fields and submit this form at least 24 hours before your appointment. This form will be securely kept in your client files. If you need assistance, please call 0402 166 415.

About 5 minutes · 14 short steps

Reason for your visit

Inspire Clinic is a physiotherapy clinic dedicated to cardiorespiratory care and rehabilitation. So we can make sure we're the right fit for you, please tick anything that applies.

Client details

Do you need an interpreter?
Interpreting. The clinic does not provide interpreting services directly. Where you need an interpreter, we will work with you to arrange one before your appointment.

Where interpreting is funded in your NDIS plan, it will be claimed against that funding. Where it is not funded, the interpreter's cost is payable by you, and we will confirm that cost with you in writing beforehand.

Where communication support is required as a reasonable adjustment for a disability, the clinic will arrange and meet that cost.

We will not proceed with an appointment where we cannot communicate safely and accurately with you.
Are you of Aboriginal or Torres Strait Islander origin?

This is the standard question used across Australian health services. Answering is voluntary, and your answer does not affect your care or what you pay.

Client contact details

Appointment reminders & updates

May we send you appointment reminders by SMS? *

Reminders go to your mobile the day before your appointment. Standard appointment and account messages are sent either way.

May we send you clinic news and health information?

Occasional only, and you can unsubscribe at any time.

Emergency contact details

Next of kin contact details

Is the next of kin the same as your emergency contact?

If yes, you do not need to fill in this section.

Best way to contact your next of kin

GP or Specialist Physician

Medicare

Do you use a different name on your Medicare card?

If you use an alias, please write the alias name & surname below.

Private health insurance

Do you have private health insurance?

Pension / HCC / DVA card

Do you have an aged pension card, healthcare card or a DVA card?
Card type
DVA card type

What to bring to your first appointment

To help us get the most out of your first visit, please bring:

  • A list of your current medications
  • Your puffers / inhalers
  • Any nebulised therapy you use
  • Pathology reports

Access to your imaging and test results

Prior imaging and test results tell us a great deal about your heart and lungs, and save you repeating investigations you have already had. With your consent, we may request reports from the radiology or pathology provider who performed them, or from your GP or treating specialist. We request reports only — not your wider medical record — and only where they are relevant to your cardiorespiratory care. You may decline, or withdraw your consent at any time, and your care will not be affected.

Do you consent to Inspire Clinic requesting reports of your prior imaging and tests (X-ray, CT, ultrasound, lung function, pathology)?

Consultation documentation (i-scribe)

To support accurate record-keeping, your clinician may use i-scribe — an AI ambient documentation tool provided by Akuru Pty Ltd. With your consent, it runs quietly in the background during your consultation, listens and creates a text transcription that your clinician reviews and edits before any notes are added to your record. It assists with documentation only and does not replace your clinician's judgement. No audio recordings are stored; text transcriptions are encrypted, stored in Australia and handled under our Privacy Policy. Using i-scribe is optional — you may decline now or withdraw your consent at any time, and your care will not be affected.

Do you consent to your consultations being transcribed using i-scribe?

Signature

Prefer to register over the phone? Call us on 0402 166 415.