Osteopathy Consent Form

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Please fill in this consent form prior to coming into the clinic.

Email *

Record my email address with my response

Patient Name: *

Date: *

YYYY

I confirm that I voluntarily consent to receive osteopathy assessment and treatment provided by Clinic4Sport. I understand that treatment may include, but is not limited to:

• Physical assessment • Manual therapy • Exercise rehabilitation • Soft tissue techniques • Spinal and joint mobilisations/manipulations • Advice and education regarding injury management and recovery

I acknowledge that:

• The nature and purpose of the treatment has been explained to me. • I have had the opportunity to ask questions. • While osteopathy is generally safe, no guarantee of specific results can be given. • I understand that I may stop or withdraw consent to treatment at any time. • I confirm that I have disclosed any relevant medical conditions, injuries, medications, or concerns that may affect my treatment.

By signing and submitting this form electronically, confirm that I have read, understood, and agree to the above consent for osteopathy treatment provided by Clinic4Sport, and that the medical information I have provided is accurate to the best of my knowledge.

Patient Signature:

A copy of your responses will be emailed to .

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