Physiotherapy clinic booking form 24/25 season
Please answer the questions in the form below and file your response before Tuesday 12pm (confirmed by a parent for those under 18 years old). 

Clinic starts at 7pm and players are usually seen in a first come first served order. 

If you are under 16 you will need to bring an appropriate adult with you.

If you have symptoms of or have tested positive for COVID-19 we request that you do NOT attend clinic.
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Email *
Full name *
Contact phone number *
Date of birth (if under 16 the player must be accompanied by a parent or guardian). *
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Have you paid your subscription for 2024/25 season? *
Date of intended physio appointment *
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Where on your body is your injury located? *
Give a brief description of how and when the injury happened and your symptoms
Any past medical history or medication your physio should be aware of? *
Have you tested positive for or have you had any symptoms of COVID-19 in the past 10 days? *
If Yes please do not attend physio clinic
If you have sustained a concussion please visit the links below for further information:
RFU Concussion Fact Sheet: HEADCASE_Essential-Guide_Aug_2023.pdf (keepyourbootson.co.uk)
By attending your clinic session you are giving your consent to assessment and treatment.  If you do not wish to give consent please inform your therapist at any time.
A copy of your responses will be emailed to the address you provided.
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