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NEW Patient information

Your first treatment will involve a detailed health history and note any specific concerns you may have.

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A full Chiropractic, spinal and nervous system examination will be provided. Occasionally X-Rays or other scans may be required. Rigby Family Chiropractic refers out to radiology centres that usually bulk bill for these images.

NEW Patient form

For your convenience, you can complete the Online NEW PATIENT FORM or if you prefer, download the form and bring with you to your first visit.

NEW Patient form

Fee schedule

New Patient:  $140.00

Regular Patient:  $70.00

Student / Pensioner:  $65.00

Extended Consultation:  $140.00

All of our Chiropractors are fully registered with Private Health Funds, Hicaps, Veterans Affairs and accept Medicate EPC plans with GP referral.

Fee schedule
Online NEW patient form

NEW PATIENT FORM

Your details

Do you have health insurance which covers Chiropractic care?

Health insurance Required

Have you had Chiropractic care before?

Previous chiropractic Required

Your health

If you have no specific problems and are here for wellness care,

please tick​

If not, what is your main health concern?

What do you believe caused this complaint and when did it start?

List any medications / vitamins / supplements being currently taken

List any operations you have had and when

List any accidents, fractured bones or personal injuries you have had and when

Please list all X-Rays you have had in the past five years

Your habits

COFFEE

Coffee Required

TEA

Tea Required

TOBACCO

Tobacco Required

ALCOHOL

Alcohol Required

SLEEP

Sleep Required

Your family history

Heart disease

Diabetes

Cancer

Arthritis

Stroke

Thyroid disease

Consent to Chiropractic care

Changes to the law now require all Chiropractors who adjust / manipulate the spine, to warn patients of material risks. In extremely rare circumstances, some treatments of the neck may damage a blood vessel and give rise to a stroke, or stroke like symptoms. Approximately 1 in 5,850,000 neck manipulations, Haldeman et al., Spine vol. 24-8, 1999.


Whilst this has never occurred in our practice, we are still required to warn you. If any adjustments are required you will be tested before hand, as has always been our practise.


Other very slight risks include strain / sprain injuries to a ligament, muscles or disk in the neck (less than 1 in 390,000) or the low back (1 in 62,000).

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Chiropractic adjustments of the spine are internationally recognised as being far safer in dealing with neck and lower back pain than medication and many other alternatives. A risk assessment of cervical manipulation, JMPT, 1995. Mango Report, Ontario Ministry of Health, 1993.


Many adverse reactions are the results of an underlying health condition or predisposed by other health factors, which is why it is important to inform the Chiropractor of all your health problems (e.g. a history of cancer or osteoporosis may predispose you to fractures which is an important factor in the Chiropractor's decision on the adjustment or treatment procedures).

If you know you are at risk or think that you may be predisposed to suffering any of these effects due to an underlying condition, please describe them below:

Please read the following carefully:

  1. I understand that the Chiropractor will endeavour to minimise such events / reactions.

  2. I also acknowledge that I have the opportunity to ask questions about the nature, extent and purpose of care to be provided.

  3. I acknowledge that I am aware of the potential risks and I appreciate that like all health care modally, results are not always guaranteed.

  4. I do not expect the Chiropractor to be able to anticipate all potential risks and complications associated with the proposed care.

  5. I hereby acknowledge my consent to Chiropractic care and I understand that I can withdraw my consent at any time.

Privacy

The patient hereby acknowledges that the health information collected above is required by the Chiropractor at Rigby Family Chiropractic to provide effective and appropriate treatment to the patient.


The patient consents to and authorises the collection of such information by the Chiropractor and from other Health Service providers as listed below, and agrees that the patient's medical record may be retained by the Chiropractor for the purpose of future treatment.

Other Health Service providers from whom health information may be requested:

Please note

If you consider yourself eligible for our pensioner's fee or have a health care card, please discuss this with our receptionist (and provide some source of identification).

 

We appreciate 24 hours notice for appointment cancellations – this enables another patient who needs Chiropractic care to use your appointment time.

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