Our patient agreement


Please read and submit the registration and consent form below before your appointment. Note that this is our patient agreement with you so you should read through carefully to make sure you’re happy to proceed. By submitting this form you are agreeing to the terms and conditions set by Body Logic.

Your appointment is not confirmed until you have received confirmation via email.

Personal details

Date of birth(Required)

Health insurance

If you are a BUPA patient, please ensure you have your authorisation code and that you know whether the code is for standard physiotherapy OR shockwave therapy. Please confirm which by ticking the appropriate box below.(Required)
If you are NOT a BUPA patient, please tick "Not using BUPA"

Medical conditions

Do you have any of the following medical conditions? (Please select yes or no)

Other medical information


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.(Required)
Occasionally (a handful of times a year only) we may share special offers, important clinic updates and information that may be of interest to you (We will never spam you!)(Required)
This field is for validation purposes and should be left unchanged.