If you attend an appointment, MyCorePhysio will need to document your information and consents as listed below.

Your details 

      • Title:
      • Surname:
      • Forename:
      • Middle name:
      • I like to be called:
      • Date of birth:
      • Postcode:
      • Gp practice

Consent for treatment

MyCorePhysio will not ask you for your written consent for treatment, unless the nature of the treatment requires this. Instead, you will be asked for your verbal consent to treatment at each session, which will be recorded in your physiotherapy notes. Your consent must be informed by an explanation, and voluntary. You have the right to refuse treatment.

MyCorePhysio needs to document your consent or refusal to specific things listed below.If you need help filling out this form, please ask.

Processing of personal information

You will be asked to give your consent for the processing of personal data for physiotherapy purposes (physiotherapy note keeping and contact details etc) 

Contacting other health professionals

Should the need arise for your therapist to contact your Gp or other medical professionals associated with your medical care, this will not happen without prior discussion.

Use of photography/video

If video photography could be used to benefit you with your course of treatment, this will be done with your own photographic device and all data held and retained by you.