Online consent form

Read each clause, tick to agree, add your typed signature, and submit. A copy is emailed to you and stored in your clinical record.

AssessmentI consent to a physiotherapy assessment including history-taking, movement testing, palpation, and special orthopaedic or neurological tests as clinically indicated.TreatmentI consent to physiotherapy treatment including manual therapy, exercise prescription, electrotherapy, and — where recommended and separately explained — dry needling, cupping, or taping. Each technique will be explained to me before use, and I may withdraw consent for any technique at any time.Records and privacyI understand my clinical notes are stored securely for at least 8 years and may be shared with my treating team, referring doctor, or insurer only with my explicit consent, as described in the privacy policy.CommunicationI agree to receive appointment reminders, exercise reminders, and clinical follow-ups via WhatsApp, SMS, or email at the contact details I have provided.

Full name *Phone *Date of birthEmail (for a copy of this consent)Typed signature (your full name) *

By clicking submit, you agree that a typed signature has the same legal force as a handwritten one for the purpose of this consent (Information Technology Act 2000, s.10A). You may withdraw consent at any time by emailing us or telling any therapist.

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