Physiotherapy treatment is generally an effective and safe form of treatment however like any treatment there are benefits and risks. The purpose of this form is to let you know what your rights are and how we address the issue of collaborative decision making and informed consent between physiotherapists and patients.

Physiotherapists in this practice will discuss your condition and options for treatment with you so that you are appropriately informed and can make decisions relating to treatment. You may choose to consent to or refuse any form of treatment for any reason including religious or personal grounds. Once you have given consent, you may withdraw that consent at any time.

Questions of a personal nature

Your physiotherapists may ask personal questions relating to your injury and how your injury impacts on your activities of daily living. The more information you provide, the more likely it is that your physiotherapist can provide effective treatment. It is your choice as to what information you choose to provide. If you feel uncomfortable with a particular question or group of questions, please let the physiotherapist know and they will cease.

Physical contact

During the examination, assessment and treatment it may be necessary for your physiotherapist to make physical contact. Your physiotherapist will ask your permission before making physical contact with you in any way. Wherever possible, contact will be made using a towel or other forms of screening. Physical contact requires your express consent. You may withdraw consent at any time at which point, all physical contact will cease immediately. Please inform your physiotherapist if you are uncomfortable at any time.

Risks related to treatment

As with all forms of treatment, there are risks and benefits. The physiotherapist will discuss any foreseeable risks with you prior to administering treatment. In some cases, the physiotherapist may ask you to read information related to a particular treatment and they may request that you sign a further consent form. This is to ensure that you fully understand any risks involved. You may withdraw your consent at any time even if you have previously signed a consent form.

Consent for Others

CHILDREN & MINORS: Consent from a parent or guardian is required to treat minors.

We are committed to providing and maintaining a safe environment to all children and young people. A copy of our Child Safe Environments Policy is available upon request. Please ask our friendly Reception Staff. We encourage any concerns or problems to be discussed with management or one of our helpful staff.

SUBSTITUTED CONSENT: Where a person is incapable of understanding the risks and benefits of treatment, consent may be provided by another person legally authorised to provide such consent. Evidence of legal authorisation is required in such circumstances.

Privacy Policy

Health on Grange Physiotherapy adheres to the Management of Health Information in Private Medical Practice Privacy Policy, which is available to all patients for inspection. Your personal information with regards to your condition and management may be discussed either verbally or in writing to your *Doctor *Rehabilitation Provider *Occupational Therapist *Other Treating Therapists. You may withdraw your consent at any time, please advise your Physiotherapist if you wish to do so.

You need to let us know

The risk related to some treatments can increase if the physiotherapist is not aware of certain facts. Please inform the physiotherapist if you have:

• A pacemaker or heart condition
• Suffered from blood clots, thrombosis or stroke
• Suffer from diabetes
• Are currently taking medication