Occupational Therapy Consent template

1. Nature of Occupational Therapy

• Occupational therapy supports my ability to carry out daily activities through assessment, hands-on treatment, adaptive equipment, and home or workplace recommendations, tailored to my individual goals.

2. Risks and Benefits

• Occupational therapy is generally low-risk but may involve physical activity that causes temporary fatigue or discomfort. Benefits vary between individuals and no specific outcome is guaranteed.

3. Home and Environmental Assessments

• Where relevant, I consent to my therapist assessing my home, workplace, or other environments to identify adaptations or equipment that may support my independence.

4. Confidentiality and Data Protection

• My information is confidential and processed under the UK GDPR and Data Protection Act 2018, and may be shared with other members of my care team with my consent.

5. Cancellation Policy

• I agree to give at least 24 hours' notice to cancel or reschedule an appointment.

Client Information

• Full NameText
• Date of BirthDate
• Referring ConditionText
• Phone / EmailText

Therapist Information

• Therapist NameText
• HCPC Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Therapist SignatureSignature
• Date signed (therapist)Date

• By signing below, I confirm I have read and understood this consent form and voluntarily agree to occupational therapy assessment and treatment.