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Client Setup
  1. This form is for new clients applying for an account. For those that wish to update existing account details, please fill in the Existing Client Update Form. Please complete all of the fields below to help us streamline the medical bookings processes. Use next and previous buttons down the bottom to navigate through the form pages.
  2. 1. Business Information
  3. Trading Name*
    Please enter a Trading Name.
  4. Company/Business Name*
    Please enter a Company Business Name
  5. Trading Category*



    Please select a Trading Category
  6. ACN
    Invalid Input
  7. ABN
    Invalid Input
  8. Industry Type
    Invalid Input
  9. Street Address*
    Please enter a Street Address
  10. Postal Address*
    Please enter a Postal Address
  11. State*
    Please select your state.
  12. Postcode
    Invalid Input
  13. Main Telephone*
    Please enter a Telephone Number
  14. Main Fax*
    Please enter a Fax Number
  15. Year Commenced
    Invalid Input
  16. Number of Employees
    Invalid Input
  17.  
  1. 2. Director / Proprietor / Partner Details
  2. Director / Proprietor / Partner Name 1
    Invalid Input
  3. Director / Proprietor / Partner Address 1
    Invalid Input
  4. Director / Proprietor / Partner Name 2
    Invalid Input
  5. Director / Proprietor / Partner Address 2
    Invalid Input
  6. Director / Proprietor / Partner Name 3
    Invalid Input
  7. Director / Proprietor / Partner Address 3
    Invalid Input
  8.  
  1. 3. Trade References
  2. Reference 1
    Invalid Input
  3. Type of Business
    Invalid Input
  4. Telephone
    Invalid Input
  5. Reference 2
    Invalid Input
  6. Type of Business
    Invalid Input
  7. Telephone
    Invalid Input
  8.  
  1. 4. Invoicing for Medicals, Travel & Company Funded Services
  2. Preferred Billing Name*


    Please select the Preferred Billing Name
  3. Preferred Delivery Method*



    Please select the Preferred Delivery Method
  4. Accounts Contact
    Invalid Input
  5. Accounts Telephone
    Invalid Input
  6. Accounts Fax
    Invalid Input
  7. Accounts Email*
    Please enter an Accounts Email Address
  8. Invoice Address
    Invalid Input
  9. State
    Invalid Input
  10. Postcode
    Invalid Input
  11.  
  1. 5. Invoicing for Worker’s Compensation & Injury ManagementServices
  2. Invoicing Details


    Invalid Input
  3. Accounts Contact
    Invalid Input
  4. Accounts Telephone
    Invalid Input
  5. Accounts Fax
    Invalid Input
  6. Accounts Email
    Invalid Input
  7. Invoice Address
    Invalid Input
  8. State
    Invalid Input
  9. Postcode
    Invalid Input
  10.  
  1. 6. Medical Results Report
  2. Prefered Delivery Method
    Invalid Input
  3. Authorised Contact
    Invalid Input
  4. Authorised Contact Phone
    Invalid Input
  5. Authorised Contact Fax
    Invalid Input
  6. Authorised Contact Email
    Invalid Input
  7. Results/Reports Address
    Invalid Input
  8. Results/Report Options



    Invalid Input
  9. Own Paperwork
    Invalid Input
    (Please Note: An additional administration fee is charged when own paperwork is requested)
  10.  
  1. 7. Preferred Kinetic Clinics
  2. WA Clinics
















    Invalid Input
  3. VIC Clinics




    Invalid Input
  4. QLD Clinics






    Invalid Input
  5. NSW Clinics



    Invalid Input
  6. NT Clinics

    Invalid Input
  7.  
  1. 8. Your Information
  2. Your Name
    Invalid Input
  3. Your Position
    Invalid Input
  4. Your Email Address
    Invalid Input
  5. Your Direct Contact
    Invalid Input
  6. 9. Terms and Conditions
  7. Terms and Conditions*
    Please read and agree to the terms and conditions.
  8. 9. Submit
  9.   
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