Physical Therapy Consent template

1. Nature of Treatment

• Physiotherapy treatment may include manual therapy, exercise prescription, electrotherapy, and other techniques to assess and treat movement or musculoskeletal conditions. Treatment will be explained before it begins.

2. Risks and Side Effects

• Physiotherapy may cause temporary soreness, bruising, or discomfort. Rarely, manual techniques carry risk of injury, which will be discussed where relevant to my treatment.

3. Physical Contact and Draping

• I understand treatment may involve physical contact and, where needed, exposure of the area being treated, with appropriate draping and my ongoing consent.

4. Confidentiality and Data Protection

• My health records are confidential and processed under the UK GDPR and Data Protection Act 2018, and may be shared with my GP or other care providers with my consent.

5. Cancellation Policy

• I agree to give at least 24 hours' notice to cancel or reschedule; late cancellations may incur a charge.

Client Information

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

Physiotherapist Information

• Physiotherapist NameText
• HCPC Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Physiotherapist SignatureSignature
• Date signed (physiotherapist)Date

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