PATIENT DETAILS AND CONSENT FORM - Physio Rehab Group - physiorehabgroup co 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the 'PERSONAL DETAILS' section. Enter your name, address, phone numbers (home, work, mobile), email address, date of birth, occupation, and details of your doctor and emergency contact.
  3. List any sports 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 provided in the form.
  5. In the 'HEALTH INFORMATION' section, answer each health-related question by circling YES or NO. This is crucial for your safety during treatment.
  6. Review the 'CONSENT TO TREATMENT' section carefully. By signing here, you agree to the terms outlined regarding treatment and payment responsibilities.
  7. Finally, sign and date the form at the bottom to complete your submission.

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