Our forms are designed to be submitted online for your convenience.
Smart Health treats all information submitted confidentially and securely in accordance with our Privacy Policy.
If you do not wish to submit forms online simply contact our Administration Team on 8293 1100 and we will ensure that you can complete any forms and questionnaires required for your appointment through other means.
Allied Health Patient Forms
All new clients to Smart Health must complete a Patient Contact Details Form and a Medical History & General Health Form. For clients under the age of 16 years, we require an age-specific Medical Health Form to be completed.
New Patient Forms
Allied Health Patient Contact Details Form
Allied Health 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)
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
Medical Patient Forms
New patients to Dr Ramona Chryssidis must complete both a Dr Chryssidis Patient Contact Details Form and a Dr Chryssidis Medical History & General Health Form.
Dr Chryssidis Patient Contact Details Form
Dr Chryssidis Medical History & General Health Form
New patients to Dr Su-Min Wong must complete a Dr Wong Patient Details Form.
Medical General Consent Form
Dr Wong Patient Details Form
Other Medical Forms
Telehealth Consultation Consent
Medical Information Release Form
Other
Medico Legal
Authority to release obtain information
Referral Form