Thank you for consulting with us. It is important that you get to know and understand the salient points of physical therapy. In addition, just like any other medical treatment, there are benefits and risks involved in this treatment. We shall explain it also here in this informed consent and you can also ask if you have further questions or you need clarification. We will answer and explain them to you. Before a procedure shall be done, we will make sure to explain them to you first.

Please note that you have the right to decline any part of the treatment before or during treatment. You have the right to ask your physical therapist about the treatment plan and discuss the potential risks and benefits of the treatment.

What is Physical Therapy?

Physical therapy is a rehabilitation method that helps patients gain or regain their physical activities that they lost or that they are incapable of doing due to defects either from birth or resulting from injuries or disease. There are various methods of treatments to help one to regain and/or improve his or her physical function. 

How Physical Therapy is Done

Physical therapy is often done with the help of guided exercises. Some use additional agents such as heat or cold compress, dry needling, electricity, or mechanical devices or machines. This will depend on the issues that are needed to be addressed and the technology available for the physical therapist to utilize.

Potential Risks

As physical therapy intends to resolve the problem that the person is experiencing due to illness or injury, there are some risks that may arise during the course of the treatment such as pain and discomfort during the process of therapy. Stretching and twisting may cause some swelling and soreness of stiff muscles. Patient may experiance an increase in my current level of pain or discomfort, or aggravation of my existing injury during physical therapy. This discomfort is usually temporary; if it does not subside in 24 hours, I agree to contact my physical therapist

Expectations

There are no guaranteed expectations when one undergoes physical therapy treatment. This depends on the situation. But when one undergoes a physical therapy program, it is intended that one will be able to return to his or her prior level of functioning or develop a method to continue what was possible to be performed before the injury that is no longer possible after being permanently injured. Physical therapy I further understand that treatment does not imply a guarantee of results and I am willing
to proceed with C the Movement LLC. If, in the opinion of the treating therapist, I am not progressing in my program, I am not
attending therapy regularly or I am not arriving on time for my appointments, the therapist has the right to discharge me from treatment

When going through the program, it is important that the patient is truthful with what he or she thinks or feels. Proper communication is important for the progress of the patient.

Location

C the Movement LLC physical therapist travel to different locations to perfrom services. If the location is not safe,descresion is made by phyisical therapist, Pt will have to find another location for treatment or pt will be discharged from services

 

If location for services are out of area, outside of Ellis or Tarrent county, there will be an extra charge for drive time

Cancellation policy

Please call our physical therapist if you cannot come to an appointment already scheduled. If you do not call at least 6 hours (during business hours) prior to your appointment time, there will be a $30 late cancel fee. Failure to call or show for an appointment will result in a $50 No Show fee.

 

Physical therapy without referral

Beginning September 1, 2019, Texans who want treatment for an injury or pain management can see a physical therapist without first visiting a physician for a referral. Texas Governor Greg Abbott signed Direct Access Bill 29, HB29.  Patient is able to be seen for 10 consecutive days without referral. Following the 10 days, Patient must receive referral to contiinue

 

Payment policy

Payment will be received by either, cash, Zelle or credit prior to services being given. If no payment has been received, patient will not be seen and session will need to be rescheduled. C the Movement is a cash based company and does not take insurance
 

Confidentiality

Under the Healthcare Insurance Portability and Accountability Act of 1996 (“HIPPA”), we are required that all medical information of every individual be kept securely and shall not be disclosed to anyone. This allows the patient to have the right on how his or her information and how it shall be used.

The records we acquire from you shall be used for managing health care by health care providers and will be used for reference for payment or reimbursement for services such as billing or collection. We may also use your information for the assessment and improvement of our activities and business operations. 

CONSENT

I have read all the information provided here or it has been read to me. I understand the contents of this informative consent form. I understand the risks involved in physical therapy and agree to participate in the procedures to be conducted and comply with the established plan of care set forth by my physical therapist. I have had the opportunity to ask questions and all of which were answered to me accordingly. 

I hereby consent to the evaluation and treatment of my condition by a licensed physical therapist employed by C the Movement,LLC. The physical therapist will explain the nature and purposes of these procedures, evaluation, and course of treatment. The physical therapist will inform me of expected benefits and complications, and any discomforts, and risk that may arise, as well as alternatives to the proposed treatment and the risk and consequences
of no treatment.I also accept financial responsibility and/or
dismissal from therapy without notice for noncompliance.