← All resources / Patient forms

Before your home visit form

Access, parking, pets, who will be home and anything that keeps the visit safe for everyone, before the first home visit.

How to use it: Safety and Boundaries for Home Visit Physiotherapists

Getting to you

  1. How to get in: gate codes, stairs, lifts, which door Written answer · required
  2. Where to park Written answer
  3. A family member or carer we can contact Short answer

At home

  1. There are pets at home Tick box
  2. Someone smokes in the home Tick box
  3. Someone at home is unwell with something catching Tick box · a yes is flagged to the physio
  4. Who will be home during the visit Choose one: Just me · A family member · A carer · Not sure
  5. Where we can treat you (bedroom, living room) and any equipment you have Written answer

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.