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Beach Waves

Patient referral online form

Self Referral form

Physiotherapy referral for specialised treatment and care in Women's, Mens' and child pelvic health and continence 



ph: (07) 5500 2829

+ Helensvale +Benowa + John Flynn + Southport

Thank you for taking the time to complete this form we look forward to working with you and your patients towards optimal pelvic health

Patient symptoms and pelvic floor conditions
Referral type
Location preference
Appointment time preference

Patient information

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Privacy Policy

Our commitment to your privacy

At Gold Coast Pelvic Health and Physiotherapy, we are committed to handling personal information about you, including health information about you, in accordance with the requirements of the Commonwealth Privacy Act 1988.

In this Policy, we explain:

  • what kind of information we collect and hold about you

  • how and why we collect it

  • what we do with that information and who we share it with (and when)

  • your right to seek access to, and if required correction of, the records we hold about you your right to make a privacy complaint, to us and others

  • whether we are likely to disclose information about you to overseas recipients.

What kind of personal information do we collect about you?

We collect and hold the following kind of information about you:

  • your name, address, date of birth, email and contact details

  • information about your family or relatives

  • information about other health professionals involved in your care

  • any government identifiers such as Medicare number, DVA number. However, we do not use these for the purposes of identifying you in our practice

other health information about you such as: a record of your symptoms, your relevant medical history, the diagnosis made and the treatment we give you:

  • -  specialist reports

  • -  test results

  • -  your appointment and billing details

  • -  your prescriptions

  • -  your healthcare identifier

  • -  your help fund details

  • -  other information about you collected for the purposes of providing care to you.

How do we collect and hold your personal information?

We will generally collect personal information about you in these ways:

  • directly from you when you give us your details (eg, face-to-face, over the phone, via registration form or an online form)

  • from a person responsible for you

  • from a third party where we are permitted by law to do that (eg. other health care professionals involved in your care, from your health insurer, from the My Health Record system etc.).

Why do we collect and use information about you?

  • We primarily collect and use personal information about you to provide our physiotherapy and allied health services to you and to communicate with you and others involved in your care in relation to those services.

  • We also sometimes use that information for other purposes, including:

  • to help us manage our accounts and administrative services, including billing, arrangements with health funds, pursuing unpaid accounts, management of our IT systems and

  • to conduct accreditation, quality assurance or internal audits.

When and why might we share information about you with others?

We may disclose information about you to others outside of our practice as permitted or required under law. This will include situations where we disclose information about you in order:

  • to comply with our legal obligations (eg. mandatory reporting under legislation, responding to a court order or subpoena)

  • to consult with other health professionals involved in your healthcare

  • to get test results from diagnostic and pathology services

  • to claim on insurance

  • to communicate with your health fund, with government and other regulatory bodies such as Medicare

  • to help us manage our accounts and administrative services (eg. billing or debt recovery, arrangements with health funds, pursuing unpaid accounts etc.)

  • to lessen or prevent a serious threat to a patient’s life, health or safety or a serious threat to public health or safety

  • to help in locating a missing person

  • to establish, exercise or defend an equitable claim through the My Health Record

  • to prepare the defence of anticipated or existing legal proceedings to discharge notification obligations to liability insurers.


Your right to seek access to and to seek correction of the information we hold about you

  • You have the right to seek access to and correction of the personal information we hold about you.

  • We will normally respond to your request within 30 days.

  • To make the request, you should contact or call (07) 5500 2829

  • If you think that the information we hold about you is not correct, let us know in writing.

  • We will take reasonable steps to correct your personal information where the information is not accurate or up-to-date.

  • From time to time, we may also ask you to verify that the information we hold about you is correct and current. And please notify us if and when your contact details change on your patient portal access or via or call (07) 5500 2829

Security: how we hold your personal information

We take reasonable steps to protect the information we hold about you. These are designed to prevent unauthorised access, modification or disclosure and to prevent misuse and loss.

This includes:​

  • holding information on an encrypted database

  • getting staff to agree to patient confidentiality 

  • providing staff with training or induction etc. about confidentiality and (in particular) security issues

  • strong password protections when accessing the information on a computer


Your right to receive treatment from us anonymously (or by using a pseudonym)

  • Where it is lawful and practicable for us to do so, you can be treated anonymously or through use of a pseudonym (a name other than yours).

  • Disclosing information about you overseas

  • We do not propose to disclose information about you to anyone overseas. If we want to transfer your personal information overseas, we will first seek your consent, unless we are required by law to do the transfer.


If you have a privacy-related concern about us

  • If you have concerns about the way we’ve handled your privacy, let us know. You should do that in writing. We will then try to respond to you within 30 days.

  • If you are not satisfied with our response, you can refer your complaint to the Office of the Australian Information Commission, whose contact details are:

Phone: (07) 3234 7373 or 1800 642 753


Post: PO Box 10143, Adelaide Street Brisbane, Queensland 40001.



Updating this policy

We will update this policy from time to time, to reflect any changes in our information-handling practices or the law or both. We will notify you of changes to the policy by updating our website and providing updates at our front reception desk.

How to contact us

To contact us about any privacy related issues, please approach: ATTN: Admin Manager


Our cancellation policy: 

We please require a minimum of 24 hours notice if you wish to cancel your appointment.

Late cancellations significantly impact practitioners and the clinic, letting us know you are unable to attend appointments provides the practice with an opportunity to offer the appointment to other clients from our long waiting list.  

If you cancel or do not attend a scheduled Physiotherapy without providing 24 hrs notice, a 75% fee will be charged.

After more than two failures to attend or late cancellations, we will charge you the full cost of the treatment and you will be required to pre-pay for any future appointments. At any stage, if you fail to attend any appointments, all future appointments will be canceled and you will be required to reschedule.

We ask clients to make every effort to keep their scheduled appointments to avoid us having to turn other clients away when we are fully booked.

Motor Accident Insurance and Workers Compensation Insurance does not generally cover charges for non-attendance. These charges will need to be met by the client.


  • We accept all care plans from GPs

  • DVA

  • Work cover and insurance claims

  • All Private health insurers 

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