Client Intake Form


Congratulations on taking the first step to improving your health and wellbeing.
We look forward to meeting with you and helping you achieve all your personal goals.
Just fill out the following form for your appointment and press submit, this will then allow you to pay your booking deposit securely.
We wish you every success and know that you will soon join the growing number of Australians who are enjoying being healthy and free!
If you have any questions just give us a call on 1300 928 961
The protection of your privacy is very important to us. Riverina Mind Design is committed to protecting and respecting your privacy.
We only collect information about you to provide you with the best possible service.
Any information you supply to Riverina Mind Design is considered private and confidential and will not be supplied to other parties outside of our business.
This privacy policy discloses our current privacy practices. If we make changes to this policy, we will inform you via email or on our website.

Confidential Client History & Personal Information