Patient Survey


Stage 4 restrictions in Victoria limit a number of activities including who can access physiotherapy and other allied health treatment (including exercise physiology).

As previously communicated Healthy Bodies Physiotherapy remains open for face to face consultations. Patients are permitted to travel greater than 5km to receive health care and do NOT require a GP referral to attend.

You are receiving this survey to determine whether face to face treatment is necessary in your case under stage 4 restrictions.

The below checklist will help to determine this, or if your appointment should be conducted as telehealth (over phone/video) or rescheduled until after Stage 4 restrictions are lifted (after 13th September 2020).

How to proceed

Please fill out the below form and advise Healthy Bodies Physiotherapy on 9584 6919 if your appointment needs to be rescheduled or changed to telehealth.

If your care is deemed essential, please print this form and bring with you to your appointment. The form may be used as evidence of your essential travel needs.

Appointment Details


    Please answer ‘Y’ Yes or ‘N’ No to the following 3 questions to determine your eligibility for a face to face appointment.

    1. Is your ability to perform your normal activities of daily living impaired or likely to become impaired if you did not receive physiotherapy?

    Some examples of this may be:

    1. Inability to walk without gait aid such as crutches or a walking stick
    2. Inability to go upstairs without assistance from a handrail or wall
    3. Inability to sleep through the night as a result of pain
    4. Inability to perform personal care such as washing hair with both hands
    5. Inability to put on pants yourself without assistance, such as from an aid or chair
    6. Inability to do bra up without assistance
    7. Inability to chew or talk normally due to Jaw/TMJ pain
    8. Experiencing symptoms of vertigo
    9. Inability to stand for the duration required to complete my normal activities of daily living

    Some examples of this may be:

    1. If I did not have physiotherapy it is foreseeable, I would need to take medication to assist me to manage my condition
    2. If I did not have physiotherapy it is foreseeable, I would need to see my GP or specialist for assistance with my condition
    3. If I did not have physiotherapy my condition would deteriorate

    If you were able answer ‘yes’ to all of the above questions, you are eligible for face to face physiotherapy under stage 4 restrictions.

    If you were not able to answer ‘yes’ to the above questions, please contact us ASAP via 9584 6919 and we will work with you to find an alternative to face to face physiotherapy during stage 4 restrictions.

    If English is not your first language and you need assistance in completing the checklist above, please contact the clinic on 9584 6919.

    We look forward to assisting your recovery as best we can. Stay positive, Stay Safe!

    The team at Healthy Bodies Physiotherapy.

    Woman shown explaining the skeletal structure of a human body to her student