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.

Thanks for submitting!