Consent to assocaited risks:
I am informed of the potential risks associated with proposed physiotherapy treatments. They include but are not limited to burns from application of heat and cold packs or electrotherapy modalities, redness, increased discomfort, re-injury, muscle sprains and strains and fractured bones.I understand I may have increased soreness following treatment and will inform the therapist immediately of any concerns.
Consent to collect and release information:
I give my informed consent to the employees of the Clinic to obtain and/ release information from/to physicians, lawyers, family members, insurance companies, case managers, employers, hospitals or health care practitioners as deemed necessary for my continuing care or the processing of my claim. I also release the employees of the clinic from any and all claims directly associated with the release of the information. I give permission for clinic employees to contact me through phone calls and leave a message when required.
I have read the above noted consent and have had the opportunity to question the contents and my therapy. By signing this form, I confirm my consent is voluntary for the entire course of assessment and treatment. This consent cover the treatment discussed with me and such additional treatment as proposed by my therapist from time to time, to deal with my physical condition and for which have sought treatment. I understand that at any time I may withdraw my consent and treatment will be stopped.