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Physical Therapy Release Form
"I need a Physical Therapy Release Form for my private practice in Cardiff, which must include specific clauses about sports injury treatment and a comprehensive section about recording treatment sessions for training purposes."
1. Patient Information: Basic personal and contact details of the patient including name, address, date of birth, and contact information
2. Medical History Declaration: Patient's relevant medical history, current conditions, medications, and previous treatments
3. Consent to Treatment: Express consent for physical therapy treatment, acknowledging understanding of the procedure
4. Risk Acknowledgment: Recognition of potential risks and complications associated with physical therapy treatment
5. Privacy Notice: Information about how personal and medical information will be handled in accordance with UK GDPR
1. Insurance Details: Patient's insurance information and coverage details, included when treatment is covered by insurance
2. Emergency Contact: Alternative contact details, recommended for elderly or high-risk patients
3. Photo/Video Consent: Permission for documentation of treatment through photos or videos, used when required for clinical purposes
1. Treatment Plan: Detailed outline of proposed physical therapy interventions, frequency, and expected duration
2. Fee Schedule: Breakdown of treatment costs, payment terms, and cancellation policies
3. Exercise Instructions: Detailed guidance for prescribed home exercises and self-care protocols
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