Consent Form Consent Form Please enable JavaScript in your browser to complete this form.Client NameDate of birth I consent to receive physiotherapy treatment, which may include the following techniques: Please tick the type of treatment that you would preferMassage/Manual Therapy – Recommended for pain management/muscle tightness I understand this involves manual techniques to manipulate muscles and soft tissues for pain relief, circulation, and mobility.Dry Needling - Recommended for post exercise recovery I understand this involves the use of fine needles inserted into trigger points to reduce pain and muscle tension. I am aware that there may be possible minor side effects such as bruising, soreness, or dizziness. 1 in 30 needles cause a small bleed. Contraindications to treatment include: open wounds, HIV positive clients, bleeding disorders.Cupping Therapy I understand this involves suction cups placed on the skin to enhance circulation and relieve muscle tension. I am aware this may cause temporary marks or bruising.Sports StrappingWe use hypoallergenic sports strapping to provide support to an area that is strained. This would help with e.g. pain/tightness and can be worn for up to 3 days. It is best if this is applied to dry skin. applicable) if Acknowledgements: Past Medical History (Please tick if applicable)Heart conditionStroke / Neurological conditionDiabetesPrevious surgeriesLow back painOtherAdditional details (if any):Risks & Acknowledgements:I understand that while physiotherapy treatments are generally safe, there are potential risks or side effects associated with each technique.I can withdraw consent at any time.Submit Now
