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Consent to assessment and treatment form

Plain-language consent covering assessment, common treatments, the right to stop and asking questions.

What it is built on

  • Informed consent. Physiotherapy Board of Australia, Code of conduct (informed consent)

How to use it: Consent Forms for Physiotherapy: What to Include, With Free Templates

About your treatment

  1. Consent to physiotherapy To read and agree to · required Your physiotherapist will ask about your health and assess how you move. This may include touching the area being assessed, so please wear comfortable clothing. Treatment may include exercise, education, hands-on techniques, and other treatments your physiotherapist will explain first. Some people feel sore for a day or two after treatment. You can ask questions at any time, ask for a chaperone, ask for a different approach, or stop treatment whenever you wish.
  2. I understand and agree to be assessed and treated Tick box · required

Signature

  1. Your full name Short answer · required
  2. Date Date · required

Signature

The patient signs on screen, on their phone or at the front desk, and the signed copy is kept on their file.

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