01943 850723
enquiries@physio-logic.co.uk
26 Westgate, Otley, West Yorkshire, LS21 3AS
Physio Logic Ltd is committed to providing every patient with an ethical, and consistently high standard of quality healthcare. We value the importance of providing you with knowledge and understanding of your problem to ensure you feel comfortable in the management of your condition following treatment.

COVID-19 TREATMENT FOLLOW UP TRIAGE FORM

Please note the form below must only be completed where you have recently commenced a new course of treatment and have already completed the initial Covid-19 Triage and Consent Form prior to your initial consultation.

Due to the current COVID-19 pandemic the safety of everyone attending the clinic is of paramount importance. As part of new safety measures anyone attending the clinic is now required to complete an additional Triage and Consent Form. This ensures patients understand the nature of the treatment they are booked in for, and allows us to identify any potential Covid-19 risks. Access to face-to-face treatment cannot proceed without a completed form. Whilst this can be done within the timeframe provided for your treatment it would be really helpful if this could be completed online prior to your arrival. Please note our website is secured and verified with a digital certificate of security seen at the bottom of each page.

We really appreciate and would like to thank you for your understanding and patience whilst we endeavour to keep all our patients, staff and their families safe from the Coronavirus. Should there be any problems completing the form please contact the clinic on 01943 850723 or by email at enquiries@physio-logic.co.uk.

PLEASE COMPLETE ALL SECTIONS.

If the patient is under 16 years of age, this form should be completed by a parent/guardian. 

PLEASE NOTE:

NO DETAILS ARE STORED ON THIS WEBSITE. DETAILS SUBMITTED ARE REQUIRED FOR THE PROVISION OF FACE TO FACE TREATMENTS ONLY AND WILL NOT BE USED FOR ANY MARKETING PURPOSES NOR RELEASED TO ANY THIRD PARTIES.

Please double-check to ensure your email details are correctly entered as a copy of your submitted information will be sent to your email address for your records.

PLEASE READ CAREFULLY

Covid-19 is an infectious disease caused by a newly discovered coronavirus. Many people who become infected experience mild to moderate respiratory illness and recover without needing specialist treatment, however there are people at higher risk of developing a serious illness. This includes older people, and those with underlying medical problems such as heart disease, lung disease, diabetes, chronic auto-immune disorders and cancer. The most common symptoms are developing a high temperature greater than 37.5 deg C, a new continuous cough and loss or change in your normal sense of smell or taste. Other symptoms that may appear are headaches, general aches and pains, nasal congestion, sore throat, diarrhoea and fatigue.

INFORMATION AND CONSENT

If you have answered no to the screening questions, the risk to you and to other people within the practice has been deemed to be reduced. Due to the nature of face-to-face consultations and treatments, proceeding with them does in itself cause a potential risk. Whilst we have taken steps to ensure we reduce the risk of any spread of the infection we cannot guarantee completely mitigating the risk of the virus. During your consultation or treatment session your healthcare professional will discuss the treatment options available to you and the risks associated with these. They may also deem the risk of performing certain treatments does not outweigh the potential benefits and may refuse to perform certain manual treatments.



 

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