Emergency Contact Information
Your Medical History
It is important that you answer these questions as honestly as
possible to ensure
you receive the best possible treatment. If you are not happy about any of the
disclosure, please discuss this with your therapist, as these conditions or
medications could have an effect when having an assessment or treatment.
Your GP's Information
Consent to being treated by a Therapist
Consent given is in light of full information of risk of failure or
complication
as well as alternative therapies available.