Registration and Consent Form for Treatment





Registration and Consent Form for Virtual and Clinic based treatment

Please read carefully, complete your details and confirm your consent to register.

Note: An appointment is not confirmed until you have received confirmation via text message.

Your Details




Health Insurer Details (if applicable)

You are liable for ANY outstanding sums unpaid by your insurer/referrer. With all insurance clients YOU the patient are responsible for informing Body Logic of the number of sessions authorised by your insurer NOT Body Logic. Body Logic does not liaise with your insurer on this matter. If you come for a session YOU must be certain that your insurer will pay.

By completing the below insurance details, you consent to the above.


Medical Conditions


Physiotherapy examination and treatment (with some exceptions re virtual physiotherapy)

Examination is the assessment of movement, body position, specific body structures and the way these interrelate. This often involves clothing being removed and the physiotherapist using his/her hands to palpate (assess by feel) areas of possible involvement with your problem. If you have any reservations about this please discuss them with the physio before your treatment begins.

After your examination, the findings will be discussed with you and a treatment plan established. You are urged to ask about anything you do not understand, and to have your say in determining the way forward. Treatment may include manual techniques, stretching, massage, exercises, electrotherapy (eg ultrasound), heat or cold and a home program.


Yes, that's fineNo thanks


Consent and General Data Protection Regulation (this our agreement with you)

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