Forms

If you are a new patient and need to fill out an Enquiry Form and an Intake Form, click the buttons below

Enquiry form

Intake form

If you have been seeing Dr. Binjemain at IMH Gold Coast or NIIM Gold Coast or Dr Eddie Osborne at Lotus Holistic Medicine, please click the link below to request your notes to be transferred to WIllowVale Clinic and after that, please complete the GENERAL CONSENT FORM (compulsory for attendance)

Notes transfer form for IMH

Notes transfer form for lotus holistic medicine

general consent form

If you are wanting to have a follow up appointment with Dr. Binjemain or Dr Osborne, please click the link below to fill out the follow-up form. If the form is not sent 48hrs before your appointment, we may have to give away the appointment to another patient, as we need time to gather together necessary test results for your appointment. 

follow up form

If you are having or planning to have an appointment with our clinical psychologist or biofield / sound therapist or intravenous therapy, please read and sign this CONSENT FORM

Treatment consent form