PATIENT DETAILS AND CONSENT FORM - Physio Rehab Group - physiorehabgroup co 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out your personal details. Enter your name, address, phone numbers (home, work, mobile), email address, date of birth, occupation, and doctor/s. Ensure all information is accurate for effective communication.
  3. List any sports, hobbies, or recreational activities you regularly engage in. This helps the clinic understand your lifestyle better.
  4. Indicate your ethnic background by circling the appropriate option from the provided list.
  5. Identify how you were referred to the clinic by circling one of the options available.
  6. In the health information section, answer each question by circling YES or NO. This is crucial for your safety during treatment.
  7. Review and sign the consent to treatment section. Make sure you understand your rights regarding treatment and payment responsibilities before signing.
  8. Finally, date your signature to complete the form.

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I have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. I understand that I will be given a copy of this consent form.
Obtaining informed consent in medicine is a process that should include describing the proposed intervention, emphasizing the patients role in decision-making, discussing alternatives to the proposed intervention, discussing the risks and benefits of the proposed intervention, and eliciting the patients preference,

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