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New Patient Form

    First Name *

    Last Name *

    Email *

    Address *

    Used only if you would like us to contact your GP.

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    Zip Code


    Do you have any pre-existing medical conditions or concerns that we should be aware of?

    I consent to a verbal history, relevant clinical assessment and, after a report of findings, treatment if deemed necessary *

    We always explain everything before our history, assessment and treatment. We will never do anything without your consent and you can decline or revoke consent at any time.

    I consent to receiving emails from Summit Wellbeing regarding my treatment, exercise program and clinic news *

    We never share your information with anyone and we only ever contact you with relevant clinical information and treatment advice.