New Client Intake Form

Welcome to Yodgee's Health & Fitness. To help us tailor your upcoming session precisely to your body's physical history and movement goals, please take a few minutes to complete this initial clinical intake form before your appointment. All information provided is held in strict professional confidence.

👤 Section 1: Personal Details

Name *

Date of Birth *

Email address *

Emergency Contact Name & Phone Number *

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💰 Section 2: Funding & Referral Structure

How will your sessions be managed? *

Private / Private Health Insurance
NDIS Self-Managed
NDIS Plan-Managed

NDIS Participant Number or Support Coordinator Email (if applicable) *

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🩺 Section 3: Health & Medical History

What specific outcomes are you hoping to achieve through our sessions?

Relevant Health Conditions or Diagnoses

Chronic Pain / Joint Stiffness
Hypermobility / Joint Instability
Anxiety / Stress Management
Past Musculoskeletal Injuries or Surgeries

Current Medical Considerations: Please detail any conditions/medications we should factor into your program. *

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💬 Section 4: Environment & Communication Preferences

Communication & Environment Support. Please let us know of any specific communication styles (verbal/non-verbal), sensory triggers, or support preferences we should accommodate.

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