Want to feel younger, stronger & healthier in just 6 weeks? Join the younger you challenge!
FREE FIFTY 50 PASS
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Clubs
Bundall
Burleigh
Tweed Heads
Murwillumbah
Parkwood
Carindale
Castle Hill
Dee Why
About Club Active
The Founder
Our Journey
Partner with Us
Press & Media
Why Partner with CA
Our Contributions
Memberships
Younger You
Fifty/50 Group Classes
Medical Fitness Programs
Bariatric Surgery Medical Fitness Program
Cancer Medical Fitness Program
Cardiovascular Medical Fitness Program
Diabetes Medical Fitness Program
Lower Back Pain Medical Fitness Program
Multiple Sclerosis Medical Fitness Program
Osteoarthritis Medical Fitness Program
Osteoporosis Medical Fitness Program
Parkinson’s Disease Medical Fitness Program
Pre/Post Joint Replacement Medical Fitness Program
Pulmonary Medical Fitness Program
Stroke Medical Fitness Program
Allied Health
NDIS
Veterans
Aged Care Exercise Physiology
Functional Age Assessments
Book Appointment
Referral Request Form
Blog
Fact Sheets
Contact Us
Clubs
Bundall
Burleigh
Tweed Heads
Murwillumbah
Parkwood
Carindale
Castle Hill
Dee Why
About Club Active
The Founder
Our Journey
Partner with Us
Press & Media
Why Partner with CA
Our Contributions
Memberships
Younger You
Fifty/50 Group Classes
Medical Fitness Programs
Bariatric Surgery Medical Fitness Program
Cancer Medical Fitness Program
Cardiovascular Medical Fitness Program
Diabetes Medical Fitness Program
Lower Back Pain Medical Fitness Program
Multiple Sclerosis Medical Fitness Program
Osteoarthritis Medical Fitness Program
Osteoporosis Medical Fitness Program
Parkinson’s Disease Medical Fitness Program
Pre/Post Joint Replacement Medical Fitness Program
Pulmonary Medical Fitness Program
Stroke Medical Fitness Program
Allied Health
NDIS
Veterans
Aged Care Exercise Physiology
Functional Age Assessments
Book Appointment
Referral Request Form
Blog
Fact Sheets
Contact Us
Menu
Clubs
Bundall
Burleigh
Tweed Heads
Murwillumbah
Parkwood
Carindale
Castle Hill
Dee Why
About Club Active
The Founder
Our Journey
Partner with Us
Press & Media
Why Partner with CA
Our Contributions
Memberships
Younger You
Fifty/50 Group Classes
Medical Fitness Programs
Bariatric Surgery Medical Fitness Program
Cancer Medical Fitness Program
Cardiovascular Medical Fitness Program
Diabetes Medical Fitness Program
Lower Back Pain Medical Fitness Program
Multiple Sclerosis Medical Fitness Program
Osteoarthritis Medical Fitness Program
Osteoporosis Medical Fitness Program
Parkinson’s Disease Medical Fitness Program
Pre/Post Joint Replacement Medical Fitness Program
Pulmonary Medical Fitness Program
Stroke Medical Fitness Program
Allied Health
NDIS
Veterans
Aged Care Exercise Physiology
Functional Age Assessments
Book Appointment
Referral Request Form
Blog
Fact Sheets
Contact Us
Phone-alt
Free FIFTY/50 PASS
Referral Request Form
Treating Doctor Details
Doctor Name
(Required)
Practice Name
(Required)
Contact Phone Number
Practice Address
Patient Details
Patient Name
(Required)
Date of Birth
(Required)
Patient Contact Phone Number
(Required)
Patient Email Address
Patient Address
Patient Injury/Condition Details
Reason for Referral (type of injury or condition)
(Required)
Date of Injury
Claim Type
(Required)
Private Health Insurance
Private (no health insurance)
DVA
Workcover/CTP
GP Chronic Care Plan
Insurer/Claim No.
Club Active Location
(Required)
Carindale
Parkwood
Bundall
Burleigh
Tweed Heads
Murwillumbah
Castle Hill
Dee Why
Service Requested
Exercise Physiologist Treatment
Dietetics
Physiotherapy
Home Visits (aged care/DVA)
Physio Hydrotherapy (Burleigh only)
Exercise Prescription
Programs
Osteoporosis Medical Fitness Program
Osteoarthritis Medical Fitness Program
Cardiovascular Medical Fitness Program
Cancer Medical Fitness Program
Pulmonary Medical Fitness Program
Diabetes Medical Fitness Program
Step
1
of
9
11%
What's your biological age?
Take a series of questions to understand your biological age. Let's learn about you and your health goals
How does your body currently feel?
(Required)
Tired, exhausted, often in pain
Not wonderful, but trying to cope with ongoing problems
Generally happy with my energy levels and body
Really happy with overall body / health condition
My weekly activity level
(Required)
No exercise
Exercise 1-2 times per week
Exercise 3-4 times per week
Exercise 5+ times per week
Do you currently suffer from any of the below conditions?
(Required)
Chronic Pain / Injury
Osteoarthritis
Osteoporosis / Osteopenia
Cardiovascular / Respiratory disease
Hypertension
Diabetes
Balance / stability issues
Pre / Post-Operative rehabilitation
Asthma or COPD
Other
Are you interested in a consultation with any of the below allied health professionals?
(Required)
Exercise Physiologist: Tailored exercise program based on your unique needs.
Dietitian: Tailored nutrition / diet advice
Physiotherapist: Acute injury / condition management & supervision
Psychologist: assistance with mental health and achieving your goals
What would you like to change about your current situation?
(Required)
I want to increase mobility so I can do more
I want to feel better generally and have more energy
I want to meet people and increase my support network
Are you aware of Health Care / Chronic Disease Management Plan rebates available on GP referral?
(Required)
Yes, I've been referred by a GP to get assistance
Somewhat, need further details
No, never heard of this before
Do you currently access any of the following funding models?
(Required)
DVA
Aged Care
NDIS
Workcover
Do you have private Health Insurance?
Yes
No
Enter your name and email so that we can get in touch with you.
(Required)
First
Last
Email
(Required)
Best Location
(Required)
Best Location
Bundall
Burleigh
Tweed Heads
Murwillumbah
Parkwood
Carindale
Dee Why
Castle Hill
Comments
This field is for validation purposes and should be left unchanged.
