Informed Consent
Physiotherapy treatment is generally an effective and safe form of treatment however, like any treatment, there are benefits and risks. This is not a waiver form. 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 physiotherapist and patient.
Physiotherapists at Central Physio will discuss your condition and options for treatment with you so that you are appropriately informed and can make decisions relating to your treatment. You may choose to give consent to or refuse any form of treatment for any reason including religious or personal grounds. You have the right to a second opinion at anytime. Once you have given consent, you may withdraw that consent at any time.
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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 an 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.
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Physical contact
During your consultation with your physiotherapist, in order to assess and treat you correctly, it will likely be necessary for your physiotherapist to make physical contact and/or to expose the injured body part. Your physiotherapist inform you as to what treatment they recommend and if you give 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 that consent at any time at which point, all physical contact will cease immediately. Please inform your physiotherapist if you feel uncomfortable in any way.
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Risks related to treatment
As with all forms of treatment, there are risks and benefits. Some therapy techniques have a very slight risk of causing injury. Your physiotherapist will discuss any foreseeable risks with you prior to administering treatment. A remote possibility of injury to structures such as but not limited to; nerves, bones, muscles, ligaments, discs, skin or arteries exists. Research evidence indicates that skilled cervical (neck) manipulation is safer than taking anti-inflammatory medication. You have the right to decline treatment at any time.
Dry needling and the above listed techniques can occasionally cause temporary local swelling, bruising or transitory increases in the levels or distribution of pain or other symptoms. In very rare cases dry needling has been reported as being associated with bodily infections or collapse of a lung (less than 1 in 70 000- 1.27 million). Allergic skin reactions to massage oils, strapping tapes, acupuncture needles or topical applications are also a possibility. 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.
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Children and minors
Consent from a custodial parent is required to treat a minor (less than 18 years of age).
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.
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
- suffered from diabetes
- are currently taking medication
- have any allergies
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I, (patient name) ______________________________ have read and understood the above information, and give my consent to receive treatment. I agree to this consent remaining valid until such time as I withdraw my consent.
Patient signature: _________________________
Date: ____________________________________
The above must be at least 18 years of age, otherwise consent from a parent or guardian is required. Where a person is incapable of understanding the risks and benefits of treatment, consent may be provided by another person who is legally authorised to provide such consent.
Please contact your therapist immediately if you experience adverse reactions. It is important to attend follow-up appointments as arranged by your therapist to allow completion of your course of planned treatment.