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Patient Registration

To register, please take the time to fill out the information below.

Are you using insurance to cover physiotherapy? If so which company?
Level of PainNot PainfulA little PainfulPainfulVery PainfulIncredibly PainfulLevel of Pain
We offer Dry Needling is this a treatment you would consider?Absolutely notNo/ I have a needle phobiaNo, but if I am not responding to hands on care I may consider itI would be happy to consider itIts my preferred treatment optionWe offer Dry Needling is this a treatment you would consider?
What are your favoured treatment methods? Answer one or more
Do you have any other Medical Conditions

I agree to give 24 hours notice if I cannot attend my appointment (to be given to someone in need of urgent treatment). If I do not give notice I agree to pay a fee of €30. If I do not attend my appointment and I have not called, I agree to pay the full consulting fee.

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