A Company Committed to Health & Humanity
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8 Dorset Square, London, NW1 6PU, UK
Give us a Call
0345 370 8222
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info@marylebonephysio.com

Consent to Treatment

Prior to treatment we require a signature indicating you have read, understood, accepted our terms and conditions.  This must be of your own decision and not be the result of coercion by medical staff, friends or family. 

  • Treatment may include various techniques including manipulations, acupuncture and dry needling.
  • You must notify your therapists of any pre-existing health issues or contra-indications that may affect your treatment.
  • Your therapist may use a camera and software to film you in the context of medical analysis. When necessary it may be reviewed by other clinic health professionals.  These films will be securely stored with your other personal, financial and medical data.
  • You should acknowledge that we may share your private information with fellow medical professionals in lieu of referrals for medical opinions or scanning. We will always notify you if a referral to a specialist is deemed necessary for your treatment. You maintain the right to decline a referral to a specialist.
  • Should you require special assistance at appointments or a chaperone please notify our team now.

Acceptance declaration.

  • I consent to the evaluation and treatment of the condition for which I, or my child or dependant have come to Health Consultants Inc medical facilities.
  • I understand that I have the right, and the responsibility, to participate in my care and treatment. I understand that I have the right to be informed about the treatment being recommended, and the responsibility to ask questions if I do not understand it. I agree to provide accurate and complete information about my health and history and presenting complaint, to agree upon a treatment plan and follow that plan. I understand that my health care providers and facilitators will treat me with respect, and I agree to do the same.