Covid-19 Triage and Consent Form

Logo: Physio Logic in Otley, Leeds
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 CONSENT AND PRE-APPOINTMENT SCREENING FORM

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 consultation 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.

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