Thank you for showing interest in booking an appointment with Hayes Physiotherapy Clinic.
If you are a new customer then please feel free to complete our new patient registration form. This will save you waiting time at the clinic as all you’ll have to do is sign.
If you are an existing patient and wish to book an appointment with Hayes Physiotherapy, you can also do so below.
Complete your new patient registration form here
Your Details
Title:
Full Name:
Address:
Contact Numbers:
Email Address:
Date of Birth:
Occupation:
Sports/Active Hobbies:
Do you have Medical Insurance?
Your G.P.’s Details
Name & Address of G.P.:
Your Medical History
Have you had any operations?
Have you had any of the following? (If yes, please check)
Are you currently on any medication? (Please specify)
No Yes
Do you have any other medical conditions?
No Yes
Register
How did you hear of Hayes Physiotherapy Clinic?
In order to avoid spam, please answer the following question
Write the number 10 in letters
I give my permission for my G.P. to be informed in regards to this registration form.
**A minimum of 4 hours notice of cancellation is required or a cancellation fee will be charged.**
Book an appointment here
Name:
Email:
Telephone:
Problem Area:
Please list an approximate date and time you are available:
Tick the box if you are a previous patient
In order to avoid spam, please answer the following question
Write the number 10 in letters