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December 4, 2020


Insurance & Private Health Details


Private Health
TAC
Work Cover / Work Safe
DVA

CDM / EPC

December 4, 2020


24 Hour Cancellation Policy:

We kindly ask that if you need to cancel your appointment, please call at least 24 hours prior in order to avoid a charge of 50% of the fee. If we are unavailable at the time of your call, please leave a message so that we can acknowledge that you have cancelled your appointment and we can arrange to reschedule.

I agree to the cancellation policy (please sign)

December 4, 2020


Privacy Policy:

Your Body Hub is committed to the care and best practice in relation to the management of information we collect. Your Body Hub has developed a policy to protect client privacy in compliance with privacy legislation, Privacy Act 1988 (Cth), The Australian Privacy Principles and any State or Territory Privacy Laws.
Our policy is to inform you of:
- the kinds of personal information that we collect and hold;
- how we collect and hold personal information;
- the purposes for which we collect, hold, use and disclose personal information;
- how you may access your personal information and seek the correction of that information;
- how you may complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint;
- whether we are likely to disclose personal information to overseas recipients.
What kinds of personal information do we collect?
The type of information we may collect and hold includes personal information about:
- Your name, address, date of birth, email and contact details;
- Medicare number;
- Your health information and other sensitive information.
How do we collect and hold personal information?
We will generally collect personal information:
- from you directly when you provide your details to us;
- from a person responsible for you;
- from third parties where the Privacy Act or other law allows it.
Why do we collect, hold, use and disclose personal information?
In general, we may collect, hold, use and disclose your personal information for the following purposes:
- to provide a rewarding and holistic service to you;
- to communicate with you;
- to comply with our legal obligations;
- to help us manage our accounts and administrative services.
How can you access and correct your personal information?
Subject to the exceptions set out in the Privacy Act, you may seek access to and correction of the personal information which we hold about you in accordance with our access policy. If a fee is charged for providing access, you will be advised of the cost in advance. The persons to contact at Your Body Hub is the Managerial Team, either the Manager or Assistant Manager.
How can you make a privacy related complaint?
We will take reasonable steps to protect the security of your information and comply with our legal obligations. Our staff are trained and required to respect your privacy. We take reasonable steps to protect information held from misuse and loss and from unauthorised access, modification or disclosure.
If you have any questions about privacy-related issues or wish to complain about a breach of the Australian Privacy Principles or the handling of your personal information by us, please contact our Privacy Officer.
You may lodge your complaint in writing. Any complaint will be investigated by the Privacy Officer and you will be notified of the making of a decision in relation to your complaint as soon as is practicable after it has been made, usually within 30 days.
If after making contact and you are still unhappy, you can contact the Australian Information Commissioner at www.oaic.gov.au
Are we likely to disclose your personal information overseas?
We may disclose your personal information to the following overseas recipients: - any individual who assist us in providing care to you;
- anyone else to whom you authorise us to disclose it; and
- anyone else where authorised by law
Updates to this Policy
This Policy will be reviewed from time to time to take account of new laws and technology, changes to our operations and other necessary developments.
How can you contact us?
Email: [email protected]
Phone: 03 8578 6544
Postal Address: Suite 26, 445 Princes Highway, Officer VIC 3809
I agree to the privacy policy (please sign):

December 4, 2020


Services




Add Medical History










Please consult with your doctor if you are in doubt about your decision to undertake Colon Hydrotherapy. Any serious health issues must be disclosed before your treatment commences.

Colonic Hydrotherapy Agreement and Consent:
I understand the contraindications, risks and benefits of Colon Hydrotherapy. I authorise consent for “Your Body Hub” to administer Colon Hydrotherapy and acknowledge that this therapy is not a substitute for medical care or evaluation from a licensed Health Care Provider.

Contraindications/Risks

• Kidney disease
• Recent bowel / stomach surgery
• Pregnancy and child birth
• High blood pressure
• Colon cancer
• Severe and untreated haemorrhoids
• Inflamed Crohn's Disease
• Abdominal pain that is undiagnosed
• Severe arteriosclerosis (narrow arteries)
• Severe ulcers of the colon

Risks

• Nausea and vomiting
• Diarrhoea
• Cramping

Please ensure you consult your therapist regarding any medical concerns or conditions.

Benefits

• Decrease in headaches
• Promotes mental wellbeing and clarity
• Increased energy levels
• Reduction in stress and anxiety
• Decreased mood swings
• Clearer skin
• Weight loss
• Greater quality of sleep
• Increase in bowel motility

Colonic hydrotherapy may assist with:

• Relief of constipation
• Relief of diarrhoea
• Food Intolerances and sensitivities
• Irritable bowel syndrome (IBS)
• Hormone regulation
• Coeliac disease

December 4, 2020








Exercise Physiology Agreement & Consent:
I believe that to the best of my knowledge, all of the information I have supplied within this tool is correct. I also give consent to receive exercise services from Your Body Hub's Exercise Physiologists and Exercise Scientists.

December 4, 2020


Your Body Hub makes all reasonable efforts to ensure a safe and clean environment in facilitating the use by all our clients in the utilisation of our Flotation Pods.





(If Yes) If you have applied fake tan in the last 7 days please see the staff before you answer any further questions.

If you have coloured your hair in the last 7 days please see the staff before you answer any further questions.

If you have had a tattoo in the past 6 weeks please see the staff before you answer any further questions.

If you have shaved in the past 48 hours please see the staff before you answer any further questions.

If you have any type of infectious or contagious diseases or illnesses, skin disorders, or wounds please see the staff before you answer any further questions.

If you are currently menstruating please see the staff before you answer any further questions.

If you have taken any drugs or have consumed any alcohol in the past 6 hours please see the staff before you answer any further questions.



Please speak to a member of staff about options relating to anxiety.









December 4, 2020


Please describe the reason for your use of the Infrared Sauna:
Infrared Sauna Agreement & Consent:
1. The use of drugs or alcohol prior to or during the sauna session may lead to dizziness or unconsciousness.
2. Please contact and consult your physician if you are in doubt of your ability to use the Sunlighten sauna for health reasons.
3. No clients under the age of 16 are permitted in the Sunlighten sauna unless accompanied by a supervising adult.
4. Please discontinue the use of the Sunlighten sauna if you feel light-headed, dizzy or heat exhausted.
5. Sauna sessions should be limited to a maximum of 45 minutes.
6. It is advised to drink plenty of water before and after your sauna session.
7. Clients using any medications must consult a physician prior to the use of the Sunlighten infrared sauna.
8. Pregnant women should not use the Sunlighten infrared sauna.
9. Clients with a medical history of circulatory system problems should consult a physician prior to using Sunlighten sauna.
10. Clients with a pacemaker or defibrillator must not use the Sunlighten sauna due to magnets used in the construction of the sauna.
I acknowledge and accept the risks inherent in the use of the Sunlighten sauna. I voluntarily assume the risk of injury, accident, or death which may arise from the use of the Sunlighten sauna. I and any of my heirs, executors, representatives, or assigns hereby release from all claims or liabilities for personal injury or property damages of any kind sustained while on the premises, during the use of the Sunlighten sauna and from any advise provided by an employee, independent contractor or any representative.

December 4, 2020

Please read carefully and sign below:
Individuals with these circumstances should either use caution when using the infrared sauna, or they should avoid it completely. Please follow suggestions for each category which applies to you. NOTE TO ALL: Don’t be surprised if you feel a little unusual following your first couple of sessions. This would be the result of toxic build up being released and pushed out of the body. The more toxicity one has, then the more likely one is to feel unusual as with a little feverish. Through continued use this should subside as toxicity is diminished.

December 4, 2020


What is the reason for your visit?







Medical History




Massage Therapy Agreement & Consent:
*Draping will be used during this session- only the area worked on will be uncovered. Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire session*

I have chosen to consult with and hereby give consent for Massage Therapy to be provided by a Massage Therapist. Who I understand is a member of their relevant Massage Therapy Association. I have provided a detailed medical history. I do not expect the therapist to have foreseen any previous or pre-existing conditions that I have not mentioned.
I understand that Massage Therapy may provide benefits for certain conditions, however results are not guaranteed. These benefits include relief of muscular tension, relaxation, reduction in symptoms of stress related conditions and general wellbeing. I also understand that Massage Therapy may produce side effects such as muscle soreness, mild bruising, increased awareness of pain and light-headedness amongst other possible temporary outcomes. I am aware that the Massage Therapy does not diagnose illness or prescribe medications nor physically manipulate the spine. The Massage Therapist understands that I have the right to question procedures used and I expect to receive an explanation of any procedures that the Massage Therapist performs. I will tell my Massage Therapist about any discomfort I may be experiencing during my Massage Therapy session and understand that the Massage Therapist will adjust accordingly.

December 4, 2020


What is the reason for your visit?







Medical History




Myotherapy Agreement & Consent:
*Draping will be used during this session- only the area worked on will be uncovered. Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire session*

I have chosen to consult with and hereby give consent for Myotherapy to be provided by a Myotherapist. Who I understand is a member of their relevant Myotherapy Association. I have provided a detailed medical history. I do not expect the therapist to have foreseen any previous or pre-existing conditions that I have not mentioned.
I understand that Myotherapy may provide benefits for certain conditions, however results are not guaranteed. These benefits include relief of muscular tension, relaxation, reduction in symptoms of stress related conditions and general wellbeing. I also understand that Myotherapy may produce side effects such as muscle soreness, mild bruising, increased awareness of pain and light- headedness amongst other possible temporary outcomes. I am aware that the Myotherapist does not diagnose illness or prescribe medications nor physically manipulate the spine. The Myotherapist understands that I have the right to question procedures used and I expect to receive an explanation of any procedures that the Myotherapist performs. I will tell my Myotherapist about any discomfort I may be experiencing during my Myotherapy session and understand that the Myotherapist will adjust accordingly.

December 4, 2020



What activities aggravate the problem?
What activities ease the problem?




Add Medical History







How often do you exercise?
What would you like to achieve out of Osteopathy?
Osteopathy Agreement and Consent:
Osteopaths are allied health professionals that offer patient-centred approaches to healthcare and functional which recognise the important link between the structure of the body and the way it functions. Osteopaths take on a holistic approach looking at the bones, joints, muscles, nerves, circulatory system, connective tissue and organs as one unit.
When techniques are competently applied, Osteopathic treatment is recognised as being an effective and safe method of care for many conditions. However, it is important to recognise that as with any healthcare intervention, there are certain risks which you need to be informed about. Osteopathic manipulation of the joints in the neck is generally held to be very safe. There are no accurate figures available on osteopathic manipulation incidences in Australia. However, studies based on the same techniques applied by other professions resulted with stroke like symptoms vary from 1 in every 50,000 to 1 in every 5 million manipulations. Please note that not everyone who sees an Osteopath at Your Body Hub will have this technique performed. This is only one of many techniques that are used in joint therapy and only performed with the patient’s consent and if the practitioner deems it appropriate for the condition being treated. Your osteopath will never manipulate a joint without first gaining consent from you and you have the right to refuse any technique, at any time.
Please read the following carefully;
• I acknowledge that there are certain inherent and potential risks in any treatment plan or procedure. I also acknowledge that I can discuss with my osteopath the rare risks associated with my treatment which include but are not limited to muscle and joint soreness/strains, nausea, dizziness, fatigue, fractures, disc injuries, strokes (or stroke-like episodes), bleeding, bruising, inflammation and an exacerbation or aggravation of my underlying condition.
• I do not expect the Osteopath to be able to anticipate every potential risk and complication associated with the proposed treatment plan/procedure. I also appreciate that a result cannot be guaranteed
• I understand that I have the opportunity to discuss the proposed care with my Osteopath, including treatments used, lifestyle or work advice, referral to other health professions etc.
• I understand that the osteopath needs to know about my health past and present and will be asked detailed questions about my complaint, medical history, general health and any medication I may be taking.
• I understand that I can withdraw my consent at any time.
• I confirm that I have read and understood all the above and consent to being treated in the manner described above.

December 4, 2020


Physiotherapy Agreement and Consent:
I give consent to receive Physiotherapy treatment from Your Body Hub's Physiotherapists.

December 4, 2020


Respiratory / Breathing Difficulties

Skin Concerns


Salt Therapy Agreement & Consent:
I hereby declare that all information provided is correct.
Salt therapy is a natural complimentary therapy and is not acknowledged as a conventional medical treatment by the medical profession in Australia. The salt therapy may or may not, work and any results may differ from one person to another.
The Your Body Hub does not make any guarantees in respect to any results of the salt therapy.

December 4, 2020