Patient Details
Patient Goals
Objective Findings
Problem Duration
Acute0–3 months
Sub-Acute3–12 months
Chronic12+ months
Months
Years
Patient Flags — ROF Script
Condition
Part 1 Frequency
2×/week6 weeks
3×/week4 weeks
Part 2 — Number of Visits
12visits
16visits
20visits
24visits
Part 2 Frequency
1×/week
2×/week
3×/week
Label Style
X-Month
XX-Day
X-Week
Auto Calculation
Part 13×/wk × 4 wks = 12 visits
Part 216 visits
Total weeks12 weeks
Total visits28 visits
Treatment Types
Add-On Products
Common Exercise Sheets
Regional Exercise Sheets
Pricing Summary
Prepay (full plan)$1,500
⭐ GoCardless (per month)$750/mo
Downsell — 6 visits$450
Remainder after downsell$1,050
Wellbeing Chiropractic — ROF Prep Tool
ROF Reference Card

Your personalised 7-stage ROF reference card — generated from the form. Print or copy for use in the consultation.

Live Preview — Print or Save as PDF
Wellbeing Chiropractic
Enhancing Lives Through Chiropractic
Patient:  ___________________
Date:  ___________________
Chiropractor:  ___________________

The 60-Day Chronic Neck Pain Program

Based on your assessment, we have designed a personalised program to address your condition and restore long-term spinal health.

12
Part 1 — 3×/wk, 4 wks
Reduce pain & begin correction
8
Part 2 — 2×/wk, 8 wks
Stabilise & lock in results
20
Total Visits
8
Weeks
2
Months
$2,450+
Value

💳 Your Investment Options

Two simple ways to get started — both include the complete care plan
⭐ Option 1 — Recommended
3 Fixed Monthly Payments
Direct Debit · No processing fees
$750/mo
Spread across 3 months — nothing more to think about
  • All 20 visits included
  • No processing fees · No interest
  • Pause or cancel anytime — no lock-in
  • 90-Day & Freedom Guarantees
Option 2 — Prepay
Pay in Full & Save
$1,500
One payment — full plan covered
  • All 20 visits included
  • Home care program & resources
  • Priority scheduling included
  • 90-Day & Freedom Guarantees
🗓️ Outcome Guarantee

Complete your visits with no measurable improvement? We provide 8 additional sessions at no charge.

🕊️ Wellbeing Freedom Guarantee

If your circumstances change, any unused prepaid visits are refunded 100%. No lock-in, no fine print.

— — — — —   PAGE 2   — — — — —
Wellbeing Chiropractic
Enhancing Lives Through Chiropractic
50+ Locations Across Melbourne, Sydney & Brisbane
Patient:  _______________________
Date:  _______________________
Chiropractor:  _______________________

The 60-Day Chronic Neck Pain Program


Your Personalised Chiropractic Care Plan

Based on your assessment today, we have designed a personalised program to address your condition, restore function, and protect your spine for the long term.

Your 8-Week Treatment Plan — 20 Total Visits
Part 1
3×/wk, 4 wks
Reduce pain & begin correction
12
visits
Part 2
2×/wk, 8 wks
Stabilise & lock in results
8
visits
What's Included in Your Plan
— — — — —   PAGE 3   — — — — —
Wellbeing Chiropractic  —  Home Care & Investment
🏠 Your Home Care Plan
What you do between visits is just as important as what we do in the clinic.
💳 Your Investment Options
Choose the option that works best for you. All include the complete care plan.
⭐ RECOMMENDED
3 Fixed Monthly Payments
Direct Debit · No processing fees
$750/mo
Spread over 3 months — set & forget
Prepay — Full Plan
$1,500
One payment — full plan covered
🛡️ Our Guarantees to You

🗓️ Outcome Guarantee

If after completing your visits you haven't experienced a measurable reduction in pain or improvement in mobility, we will provide an additional 8 sessions at no charge. No questions asked.

🕊️ Wellbeing Freedom Guarantee

We believe you should only pay for what you use. If your circumstances change and you have unused prepaid visits remaining, we will refund 100% of those unused credits. No lock-in, no fine print.

This care plan is personalised for your visit today. Results may vary. Please inform your chiropractor of any changes to your health or medications.  |  Wellbeing Chiropractic — Enhancing Lives Through Chiropractic