Osteopath Assessment & Consent

Food – Sweet/Salty/Spicy

OTHER MEDICAL HISTORY:

Please state your previous medical history since and including birth if you are aware.

Client Consent to Assessment/Treatment Treatments may include manual the rapist where the health practitioner places his or her hands on your body. Many techniques will include contact between your body and the practitioner’s body. The Body and hand contact may include areas of your chest wall, pelvic floor and pubic bone. If intraoral work is required (work inside the mouth) disposable latex or vinyl gloves will be worn. At times, the practitioners may ask you to remove some items of clothing to facilitate treatment. If you do not feel comfortable with any part of the treatment, please tell the practitioner immediately. The techniques can be discontinued or modified to be comfortable for you. Consent re: Personal Information and Treatment I value the trust you have placed in the practitioners, and I am taking all appropriate measures to safeguard your personal information confidence. I request that you provide your consent as set out below:

I understand that the possible risks and benefits of osteopathy will be explained to me regarding my individual treatment plan and accept responsibility to inform the rapist if I do not understand any aspect of the risks and benefits. I understand that manual osteopathy is not a substitute for medical treatment and/or medications and that it is recommended that I work concurrently with my Primary Caregiver for any conditions I have. I am acknowledged that the treating manual osteopath/doctor/consultant/physician and his/her team of doctors have explained in the language I understand about the diagnosis and prognosis of my present heal the condition and explained to me in detail the treatment procedures, and protocols. I agree to protect the clinic, doctors, nurses, therapists, hospital staff, and administration from any legal issues, costs, or claims that may happen due to unexpected problems during my treatment. I understand and accept the clinic’s treatment costs.

All information provided by you is strictly confidential and will not be released without written consent except where required by law.