Individuals – Peak Preparation

New Client Information Form - Individuals

We are committed to providing our clients with the best possible service. Please assist us by completing the following information.

Title

Firstname

Surname

Preferred Name

Date of Birth

Gender

Address

Suburb

State

Postcode

Phone

Mobile

Occupation

Regular Doctors Name

Clinic Name

Address

Phone

Coach Name

Coach Number

Please tick if you see any of the following on a regular basis (within a six-month cycle):

Psychologist
Chiropractor
Physiotherapist
Massage Therapist
Dietician
Podiatrist

How did you find out about Peak Preparation?

Please Read and Accept

If presentations need to be cancelled, I will give 3 days’ notice of the cancellation. If I do not cancel with notice, I will be charged a fee.
In the event that my accounts are outstanding longer than 45 days, I will be responsible for all collection fees incurred.
I am required to pay within 14 business days for all services.

Please calculate 5 plus 4