Roz Rehab Physiotherapy Consent Form

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COVID – 19 CONSENT AND RISK FORM FOR PATIENTS ATTENDING MY CLINIC

Patient's Name *

Appointment Date *

YYYY

Consent

I have consented verbally via a virtual telephone consultation with Roz ( Roz Rehab Physiotherapy)

All risks and checklist have been explained to me clearly, following the guidelines from the Chartered Society of Physiotherapy (CSP).

The virtual consultation was completed prior to my appointment Face to Face (F2F)

All health considerations have been taken into consideration and all risk factors of Covid – 19 have been explained and have been accepted.

I agree to notify Roz Rehab Physiotherapy if I am contacted by Track and Trace two weeks either side of my treatment.

I consent to face to face treatment with Roz Martin Physiotherapy.

Please check the box to consent *

I consent

Required

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