Reset Physiotherapy
Brunswick

Informed consent & privacy

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 a collaborative decision-making and informed consent between physiotherapist and patient.

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 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. Please read and sign the following:

Questions of a Personal Nature

Your physiotherapist 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 the 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 feel uncomfortable at any time.

Risk 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.

Privacy and Your Information

We collect your contact and health information to assess and treat you, keep accurate clinical records, communicate with you about appointments and process payments and claims. Records are held in secure practice management software with access limited to authorised staff. Information is shared only with your GP, specialists or other practitioners where you have agreed, with insurers or funding bodies where you have asked us to claim on your behalf, with the providers who support the practice, or where we are required or authorised by law. You can request a copy of your record, or ask us to correct information that is inaccurate or out of date, at any time. The full privacy policy is available at resetphysiotherapybrunswick.com/privacy or on request.

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Fees, Cancellations and Late Arrival

Fees are payable at the end of each appointment. Confirming any Medicare, private health insurance or other rebate is your responsibility. Appointments cancelled or changed with less than 24 hours notice, and appointments not attended, may be charged in full. If you arrive late your appointment will still finish at its scheduled time so the clinic runs on time for everyone, and the full fee applies.

Appointment Reminders

We send appointment reminders and confirmations by text message and email so you do not miss your appointment. You can opt out at any time by telling us or replying to any message.

Tick here only if you would prefer not to receive appointment reminders.
Your details
Health screening
Diabetes  ·  Osteoporosis  ·  Blood thinners  ·  Heart condition  ·  High blood pressure  ·  Cancer history  ·  Pregnancy  ·  Recent infection  ·  None
I have read and understood the information set out in this form. I consent to physiotherapy assessment and treatment, and to my health information being handled as described. I understand I may withdraw my consent at any time. The details I have given are accurate to the best of my knowledge, and I give my consent freely.
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