Consent form

Any private health insurance?
COVID-19 Consent Form

By submitting this form, I agree to each of the above statements and release any Top To Toe Physiotherapy team member from any and all liability for the unintentional exposure or harm due to COVID-19.

 

All of the members of the Top To Toe Physiotherapy team agree they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to fight the spread of COVID-19 and other communicable conditions more thoroughly.

 

In the unlikely event that one of our therapists test positive for COVID-19 following your appointment, we will need to provide patient details to UK Health Security Agency and NHS Test and Trace. By submitting this form, you consent for your details to be passed on to UK Health Security Agency and NHS Test and Trace.

Consent for treatment and to process your details

By submitting this form, you consent to be treated by Top to Toe Physiotherapy and understand that certain communications will be required as part of that treatment either through phone, SMS or email. Communications include but are not limited to appointment confirmations and reminders, request for further details relating to your treatment and information and services relating to the clinic.

You are free to opt out at anytime by emailing info@toptoephysiotherapy.co.uk

Thanks for submitting!