Welcome to Physiomobile! We are pleased to provide you with services to address your specific condition or injury. This consent form is designed to ensure that you have a clear understanding of the proposed treatment, its potential risks and benefits, and your rights and responsibilities as a patient.

By providing your informed consent, you are actively participating in your healthcare journey and allowing our dedicated team of therapists to provide you with the best possible care and support.

It is important to read this consent form carefully and ask any questions you may have before signing it. We are committed to your well-being and are here to address any concerns you may have.

I, the undersigned patient or legal representative of the patient, hereby provide my informed consent for the treatment to be performed by the above-mentioned therapist at Physiomobile. I acknowledge that I have been informed of the nature, purpose, and potential risks and benefits of the proposed treatment.

The proposed treatment aims to address musculoskeletal or neurological conditions and promote physical rehabilitation and pain management. The treatment may involve a combination of manual therapy techniques, therapeutic massage, exercises, and modalities such as heat or cold therapy, electrical stimulation, or ultrasound. These interventions are designed to improve joint mobility, muscle strength, flexibility, and overall functional capacity.

During the treatment sessions, the therapist will assess your condition, perform hands-on techniques to mobilize or manipulate joints and soft tissues and guide you through specific exercises to improve strength, range of motion, and stability. The therapist may also provide education on posture, body mechanics, and self-management techniques to support your recovery.

The treatment plan will be tailored to your individual needs and may require multiple sessions over a period of time. The frequency and duration of the sessions will be determined based on your condition and progress. The therapist may periodically re-evaluate your progress and modify the treatment plan accordingly to ensure optimal results.

Risks:

1. Soreness or Discomfort: Following manual therapy techniques, it is possible to experience temporary soreness, discomfort, or muscle fatigue. This is typically transient and subsides within a short period.
2. Muscle Strain: In rare cases, there is a possibility of muscle strain or overstretching if excessive force is applied during manual therapy techniques. Proper assessment and application of techniques by a skilled therapist minimize this risk.
3. Existing Medical Conditions: If you have certain medical conditions or injuries, such as fractures, joint instability, or vascular disorders, certain manual therapy techniques may not be appropriate and could potentially worsen your condition. It is crucial to provide accurate medical history to your therapist to ensure safe treatment.

Benefits:

1. Pain Relief: Manual therapy techniques, when performed correctly, can help reduce pain and discomfort associated with musculoskeletal conditions. They can help alleviate muscle tension, joint stiffness, and improve overall mobility.
2. Improved Joint Mobility: Manual therapy techniques, including joint mobilization or manipulation, can help improve joint mobility, increase the range of motion, and restore normal movement patterns.
3. Enhanced Tissue Healing: Certain manual therapy techniques, such as soft tissue mobilization or massage, can improve blood circulation, promote tissue healing, and reduce inflammation.
4. Improved Functional Abilities: Physiotherapy and manual therapy can improve strength, flexibility, and stability, enhancing overall functional abilities and performance in daily activities, work, or sports.
5. Prevention of Future Injuries: Physiotherapy treatment with manual therapy techniques can address underlying biomechanical imbalances, muscular weaknesses, or faulty movement patterns, which can help reduce the risk of future injuries and improve long-term musculoskeletal health.

** It's important to remember that risks and benefits can vary from person to person. A skilled and qualified therapist will conduct a thorough assessment, consider individual factors, and discuss the specific risks and benefits relevant to your condition before proceeding with manual therapy. Open communication and trust with your therapist are crucial in optimizing treatment outcomes and minimizing potential risks.

I understand that my personal health information will be kept confidential and will only be shared with individuals involved in my care, as permitted by law. I acknowledge that I have received and read the clinic's privacy policy, which outlines the measures taken to protect the privacy of my personal health information.

I understand that the proposed treatment plan may involve multiple sessions and that the treatment plan may be adjusted based on my progress and response to treatment.

By checking the box below, I confirm that I have been given the opportunity to ask questions and that my questions have been answered to my satisfaction. I voluntarily consent to the proposed treatment and authorize the therapist named above to perform the necessary procedures as outlined.

I understand that I have the right to withdraw my consent at any time by notifying the therapist in writing. I understand that by withdrawing my consent, it may impact the effectiveness of my treatment.

Thank you for your cooperation.