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Book a Physiotherapy Appointment

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How to Book
Book a Physiotherapy Appointment

Credit Card/ Debit Card Pre-authorisation

Please be advised that all patients attending the Hospital for an Outpatient appointment are required to bring a valid Debit Card or Credit Card* for swiping. For further information regarding the Hospital’s card capture policy, please visit this link.

* excluding Amex

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Tell us who you are?

I am the patient

I am completing this on behalf of the patient

Patient Details

Title (e.g Mr, Mrs, Mx, Mz etc.)

First name:

Surname:

Email:

Contact number:

Date of birth:

Appointment Details

Please tell us the reason for your appointment:

How are you paying for treatment?

Paying for my own treatment

Through my health insurance

Communication Preferences

I consent to my Personal Data being used by New Victoria Hospital to receive information that is relevant to me. This may include updates on new clinical products, services, patient events or promotional material. For further information on how your data is used, read our Privacy Policy.

Email

Phone

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Mail

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