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INFORMED CONSENT FORM FREE CONSULTATION
Patient ID: __________________________
The purpose of this form is to obtain your consent for a consultation with a physiotherapist. The purpose of this consultation is to gain general knowledge about your condition and provide you with some guidance as to the possible causes and available treatment options or the necessity of a referral to your primary care physician.
Education and safety tips may be provided during the consultation. No treatment will be provided during this session and a full assessment would be required prior to initiating a treatment plan.
All existing confidentiality protections and handling of medical information applies to the collected information during this consultation.
SIGN & SUBMIT
by Electronic Signature
By typing my name (Patient or Guardian's full name) below, I am electronically signing this consent form.
Patient or Guardian name
Date
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physiomobility_healthgroup-logo-2021

WE ARE OPEN

AS ESSENTIAL HEALTHCARE PROVIDERS, WE REMAIN OPEN FOR IN-CLINIC TREATMENTS DURING THE PROVINCE WIDE EMERGENCY BREAK ANNOUNCED ON APRIL 01, 2021

Physiomobility continues to remain open and is not part of the lockdown. We continue to have rigorous disinfection policies and procedures in place to ensure the safety of our community and are open for patient in-person visits with all of our practitioners.

Virtual appointments are available and encouraged for those who are at a heightened risk of illness.

We remain focused on our quality of care & our continued commitment to helping our patients feel their best. For further assistance, you can contact us at 416-444-4800 during our opening hours. 

The Physiomobility Team