New Staff Registration | Innerstrength Healthcare

Welcome to Innerstrength Healthcare

There is quite a few things to get through to complete this form. You can save and come back to this as needed by clicking the save draft button at the bottom of the page.

Please select submit when you have completed the form.

Downloadable file:
Fair-Work-Information-Statement (1).pdf

TFN Declaration Form
PDF icon casual-employment-information-statement.pdf

Employment Position*

Physiotherapist

Psychologist

Dietician

Administration

Other...

PRODA (Provider Digital Access)

PRODA is an online identity verification and authentication system. It lets you securely access government online services.

You will need a PRODA account for 2 reasons:

It allows us to look after mediacre and DVA claims for you
It is the easiest and quickest way to apply for an initial or subsequent Medicare Provider number

Once you have applied for your PRODA account you will be issued a RA number, please supply this number to our practice manager who will then request to be your delegate for online claiming purposes.

Information you will need about us for your Medicare application:

Practice Name: Innerstrength Healthcare

Address: 115 Pioneer Road Grovedale VIC 3216

Location Phone: 0352297963

Email: reception@innerstrength.com.au

Is this a government funded Aboriginal and Torres Strait Islander Health Service or Aboriginal Medical Service? No

Employment Status: Employee Salaried

ABN: 46 117 359 527

Registered (entity) business name: The trustee for Inner Strength Health Care Unit Trust

Business Type: Company

Premises Type: Practice - other private practice

Does this practice use Medicare Online? No

Does this practice use Medicare Easyclaim? Yes

Name the financial institution that supplied the EFTPOS device: HICAPS

Bank Account Details

Account Name: Inner Strength Health Care Pty Ltd

BSB: 633-000

Account No: 138329230

Once you recieve your confirmation of Medicare provider number please supply this to our practice manager including the confirmation email or letter so we can get you set up in the HICAPS machine for private healthfund claiming. HICAPS do require a copy of the confirmation letter for this to go ahead.

Personal

Name *

DOB *

Address *

Phone *

Email *

Emergency

Emergency Contact name *

Emergency Contact number *

Relationship

Bank Details

Bank Name *

BSB *

Account Number *

Tax

Tax file number *

Questions	Yes	No
Claiming Tax free threshold *	Yes	No
Do you have a HECS or STSL debt *	Yes	No
Completed the TFN declaration *	Yes	No

Superannuation

Superannuation Fund Name *

Member Number *

Registrations & Certificates

AHPRA number

Expiry Date

Medicare Provider Number

PRODA RA Number

Other relevant memberships

First aid & CPR

Company

Expiry Date

Marketing & Letter templates

Biography

Qualifications for letter signature

Consent

Questions	Yes	No
I consent to my photograph and information being used for marketing on our website, social media and letters	Yes	No
I consent to sharing my contact details with ISHC staff	Yes	No

Treatments

Types of treatment you offer

Questions	Can do now	Training required	N/A
Pelvic Floor - Female	Can do now	Training required	N/A
Pelvic Floor - Male	Can do now	Training required	N/A
Pelvic Floor - Children	Can do now	Training required	N/A
Prolapse	Can do now	Training required	N/A
Persistent pelvic pain	Can do now	Training required	N/A
Bowel	Can do now	Training required	N/A
Rectal Ballooning	Can do now	Training required	N/A
Incontinence	Can do now	Training required	N/A
Pelvic girdle pain	Can do now	Training required	N/A
Post natal check	Can do now	Training required	N/A
Musc	Can do now	Training required	N/A
Pregnancy Musc	Can do now	Training required	N/A
Dry needling	Can do now	Training required	N/A
Breast (mastitis)	Can do now	Training required	N/A
TENS	Can do now	Training required	N/A
Exercise Rehab (pilates)	Can do now	Training required	N/A
Dietician - adults	Can do now	Training required	N/A
Dietician - children	Can do now	Training required	N/A
Psychology - adults	Can do now	Training required	N/A
Psychology - children	Can do now	Training required	N/A
PT	Can do now	Training required	N/A

What other service do you offer?

Available Days

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday (shared exercise rehab)

Thank you for completing this form. We look forward to working with you.

Please contact our Bri our Practice manager if you have any questions management@innerstrength.com.au