Please Read Carefully

I, undersigned, do hereby give my voluntary consent for the administration of Physiotherapy deemed appropriate by my treating Physiotherapist.

I understand that Physiotherapy treatments may include an individualised exercise prescription and various forms of manual therapy techniques such as mobilisation, manipulation, soft tissue release and stretches. Treatments may also include modalities such as heat, ice, therapeutic taping, ultrasound, laser, TENS, interferential current, shock wave and electric muscular stimulation. Other treatment options include dry needling, that involve the insertion of single use, sterile, disposable needles through the skin, into the underlying muscles.

I understand that the primary goals of Physiotherapy treatments are to help reduce my pain and improve my mobility, strength, endurance, function and quality of life.

I understand that there are very small possibilities of risks or complications that may result from the above listed treatments. I do not expect the Physiotherapist to anticipate all the possible risks and complications. I wish to rely on the Physiotherapist to exercise proper judgment during the course of treatment to make decisions based upon my best interest.

Potential small but possible risk factors:

Manual therapy: Joint and/or muscle soreness

Exercise therapy: Joint and/or muscle soreness

Electrical modalities: Minor skin irritations such as redness or rash

Therapeutic Taping: Minor skin irritations such as redness or rash

Dry Needling: Minor soreness, bleeding or bruising, nausea, fainting, infection, shock convulsions, possible perforation of internal organs, stuck or bend needles, and fetal distress in pregnant women