Mobile Physio in Melbourne’s South-East

0473 393 383

Private Intake Form

This intake form helps our mobile physio understand your goals, medical history, and current concerns so we can tailor your care from day one. It only takes a few minutes, and our team will be in touch within 1–2 business days to schedule your initial appointment. If you need help with completing this form, please don’t hesitate to contact us.

Client Details

Contact Details

Emergency Contact Details

Medical Conditions (including any surgeries and diagnoses if relevant)

Healthcare Information

Goals and Aspirations

I understand that:
  • YouGo Physio owns these records and will be kept confidential.
  • Information within these records will be shared with other staff within the organisation on and only when staff require the information to carry out their duties.
  • I can ask to see records and receive a copy.
  • Records are archived for a set period according to policy and procedure.

To the best of my knowledge, the information provided in this form is true and correct.
YouGo Physio
Facebook Instagram

Navigation

Services

Contact

South Melbourne Clinic

76-78 Market Street,

South Melbourne, VIC 3205, Australia

0473 393 383

info@yougophysio.com.au

Monday – 9 am–5 pm

Thursday – 9 am-5 pm

Mobile Physio Service

PO Box 2022, Edithvale VIC 3196

0473 393 383

info@yougophysio.com.au

Servicing Melbourne’s south-east

Tuesday – 9 am–5 pm

Wednesday – 9 am–5 pm

Friday – 9 am–5 pm

YouGo Physio acknowledges the culture, dreams, and aspirations of the Aboriginal and Torres Strait Islander people as the custodians of the lands upon which we live and work, and we pay our respects to the elder’s past, present and emerging.

© 2026 YouGo Physiotherapy Pty Ltd. ABN 62 670 272 625.

Ahpra registered physio
Australian Physiotherapy Association certified physio
Registered NDIS provider
Flag of Aboriginal Australians
Flag of the Torres Strait Islander People
Flag of LGBTQ+ community