This section of our website contains relevant and pertinent forms and questionnaires to different areas of the business. 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.
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.
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.
We would appreciate you filling in at least one of the “Questionnaires” – (please choose the questionnaire(s) that relates best to the problem that you are attending Smart Health for).
You may choose to fill out more than one questionnaire, ultimately the more information we have about your condition the more likely we’ll be able to assist you to achieve a successful result and the better that we and you will be able to gauge the success of the treatment/rehabilitation that you have with Smart Health.
Patient Contact Details Form
Medical History & General Health Form (Adults)
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)
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