Gym and Pool Membership Request and Evaluation Form (for Provider use only)

This form should be completed by a registered medical practitioner, physiotherapist, osteopath, chiropractor or accredited exercise physiologist when requesting a gym and/or pool membership for a TAC client.

To request a subsequent membership, supervising health professionals are expected to report on client progress using valid outcome measures on this form. The TAC will use this information to consider if the membership continues to be reasonable, clinically justified and outcome focused.