This section of our website contains relevant and pertinent forms, questionnaires, authority forms and outcome measures for different segments of Smart Health. Most have been designed to be filled out whilst you are online and submitted straight back to Smart Health administration whilst others may require you to print or download the form first.

New Patient Forms

All new clients to Smart Health must complete the “Patient Contact Details Form” and then the “Medical History & General Health Form”.  For all of our new clients that are under the age of 16 years, we require an age specific Medical History and General Health Form to be completed.

Essential Forms
Patient Contact Details Form
Medical History & General Health Form (Adults)

Age Specific Forms
Child Medical Health Form (0-12 months)
Preschool Child Medical Health Form (2-4 years old)
Primary School Age Child Medical Health Form (5-12 years old)
Secondary School Age Child Medical Health Form (13 years and above)

By following the procedure of submitting the form online you are agreeing to sending information about yourself over the internet.  Naturally, in accordance with our strict policies and procedures, we treat confidentiality with extreme caution and every effort is made from Smart Health to safe guard this information.  If you do not wish to send this information over the internet simply contact our administration team on 8293 1100 and we’ll ensure that you have the opportunity to use these forms and questionnaires through other means.

Forms, Questionnaires and Outcome Measures

Bike Fit Forms
Bike Bio and Bike Fit: Pre-Assessment Form
Bike Bio, Bike Fit, Bike Phys: Feedback Questionnaire

Medico Legal
Authority to release obtain information
Referral Form

Smart Bumps
Smart Bumps Medical Form

Questionnaires
Knee Injury and Osteoarthritis Questionnaire
Lower Limb Questionnaire
Modified Somatic Perceptions Questionnaire
Neck Disability Index
Örebro Musculoskeletal Pain Screening Questionnaire
Oswestry Low Back Pain Disability Questionnaire
Roland-Morris Low Back Pain Questionnaire
Shoulder Pain and Disability Index
The Quebec Back Pain Disability Scale
Upper Extremity Functional Index
DASS Outcomes