Consent Form
Physiotherapy is a patient care service provided to manage a wide variety of conditions. The purpose of physiotherapy is to treat, injury, and disability through examination, evaluation, diagnosis, prognosis, and intervention. This may include rehabilitative procedures, mobilisation, massage, exercises, and other physical therapies to help patients achieve their maximum potential and to aid recovery.
All procedures will be thoroughly explained to you before they are carried out. Responses to physiotherapy treatment vary from person to person; therefore, it is not possible to accurately predict your response to a specific treatment, modality, or exercise programme. Tom Morgan Physio Solutions does not guarantee the outcome of any treatment or that your condition will be resolved. There is a possibility that treatment may result in temporary discomfort, aggravation of symptoms, or, in rare cases, injury.
It is your right to decline any part of your treatment at any time, either before or during the session. You are encouraged to ask questions regarding your treatment plan, including the risks and benefits associated with your care.
I understand that the physiotherapist reserves the right to refuse treatment to any patient where they feel the
treatment is inappropriate or not in the patient’s best interest. I understand that the fee will still be charged in this event.
I have read this consent form and understand the risks involved in physiotherapy. I agree to cooperate fully, participate in all agreed procedures, and comply with the established plan of care.
Consent
I consent to the assessment and treatment recommended and performed by the practitioner at Tom Morgan Physio Solutions in accordance with professional guidelines. This may include mobilisation, manipulation, manual therapy techniques, soft tissue massage, taping, and exercise therapy. I understand that all treatments will be explained prior to being carried out and that I have the right to refuse any treatment at any time.
Chaperone
I understand that it is my responsibility to arrange for another responsible adult (aged 18 or over) to be present as a chaperone during my appointment. If I am unable to arrange for a chaperone to be present, I will inform Tom Morgan Physio Solutions in advance of my appointment. I understand that, in these circumstances, my appointment may need to be rearranged or cancelled.
Medical Conditions
I confirm that I have disclosed all relevant medical conditions to my clinician or included relevant conditions on the booking form, including but not limited to diabetes, epilepsy, high blood pressure, pregnancy, pacemakers, and metal implants. I understand that failure to disclose relevant information may affect the safety and effectiveness of treatment.
Payment and Cancellation Policy
I understand that payment is required in advance of each session. I agree to provide at least 24 hours’ notice if I am unable to attend an appointment. Failure to do so may result in the full session fee being charged. This policy is in place to ensure appointment availability for other patients.
Data protection
All information collected during the course of assessment and treatment at Tom Morgan Physio Solutions will remain strictly confidential and will be handled in accordance with the Data Protection Act and GDPR regulations.
