COVID 19 Information Sheet and Consent Form
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Tim Humphries BSc(Hons) MCSP MAACP     Chartered Physiotherapist
TIPTREE PHYSIOTHERAPY CLINIC                           WEST MERSEA PHYSIOTHERAPY CLINIC
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Information
During the current Coronavirus pandemic there are changes to the way we are able to offer physiotherapy assessment and treatment and specific consent is required to allow any face to face consultations.

What to Expect:

* A COVID 19 Health Screening Questionnaire and an Information/Consent Form will be emailed to you. This will need to be completed and submitted prior to your initial appointment.

* On arrival your temperature will be taken using a contactless forehead thermometer. A temperature in excess of 38 degrees C will result in the consultation being cancelled and you will be advised to self-isolate for 10 days and seek a COVID test.

* Tim Humphries will be wearing protective equipment including face mask, gloves and apron.

* Although physiotherapy is a hands-on profession the 2m social distancing requirement will be observed where possible and my surgery has been rearranged to allow for this.

* Hand sanitiser is provided for use on arrival and exit from my surgery.

* Between each patient appointment the bed, all equipment and hard surfaces will be wiped down using anti-bacterial wipes.
* Appointment times are staggered to reduce the possibility of patient to patient cross-over and contact and to allow time for cleaning.

* Unless you are exempt please wear a face mask or covering when attending for physiotherapy. You may be asked to remove this for positioning purposes, ie, lying face down on the bed during treatment.

* Once in the surgery please do not enter the office area. Please remain in the treatment room at all times.

Not all conditions will require a face to face consultation. However, if it is your preference to attend for physiotherapy you will need to consent to do so. You are aware that, although small, there is a greater risk of infection by attending for a face to face session as opposed to opting for a remote, video session, however, Tim Humphries has introduced protocols to minimise the risk of infection (as above).

Those who are more vulnerable (pregnant, known severe respiratory condition such as COPD, asthma, bronchitis, emphysema, heart failure or immune compromised) may decide NOT to attend for face to face treatment. Anyone who has received a government letter advising they should be shielding may decide NOT to come for face to face treatment.

Additionally, if anyone is uncertain, for ANY reason, about their safety of coming for a face to face consultation then they are advised NOT to attend.

At the moment Tim Humphries is not exhibiting any COVID symptoms. Should this change then he will immediately cancel any physiotherapy appointments and self-isolate for 7 days.

Please note that during the current pandemic the toilet facilities will not be available for patient use.




Consent
* You have a problem that you feel would benefit from physiotherapy intervention and it is not getting better on its own over time or is worsening.

* Your preference is to attend for a face to face consultation rather than opting for a remote, video session.

* You are aware that there is a greater risk of infection by attending for a face to face appointment but you are happy with the protocols put in place by Tim Humphries to minimise any risk of infection (see information above).

* The NHS is operating a Test and Trace Service which aims to identify people who may have directly come into contact with someone diagnosed with Coronavirus. If this is the case, and a request is made by the NHS,  you consent to your name and contact information being passed on to them.




I have read and understood the information above and  I am happy to attend for a face to face appointment *
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