+919325609388I consent to and authorize SR Healyos Healthcare LLP to administer physiotherapy treatment under the direction and supervision of the physiotherapist.
I understand that the response to physiotherapy varies from person to person and hence it is not possible to accurately predict my response to a specific modality procedure or exercise protocol.
I further acknowledge that no guarantees or promises have been made to me as to the results of physiotherapy.
I also understand that there is a possibility that the physiotherapy treatment may result in temporary aggravation of my existing symptoms.
I agree for my medical records to be accessed by staff involved in my clinical care and give permission for my assessment and treatment to be recorded for quality purposes.
I understand that if I am treated as a patient, no guarantee can be provided that a particular therapist will provide treatment. In case of leave or absence of a particular therapist, another therapist will continue treatment so recovery is not affected.
I understand and individually promise to pay the charges for the services rendered.
I understand that for any cancellation/ rescheduling of an appointment, I will have to do it 24 hours before the appointment and that if cancellation is done after that, there will be a fee.
I am responsible for making sure that I follow instructions given by the physiotherapist/doctor, failing which my recovery might be delayed or impacted.
I am completely aware that my personal information and medical records will be safe under the privacy and confidentiality policy at SR Healyos Healthcare LLP.
I am undertaking this treatment in full consciousness and with sound mind and am fully aware of the risks associated with the treatment.
I, as the patient or the legal agent of the patient, hereby certify that I have read and fully and completely understand the above conditions, and that I have signed these conditions freely, voluntarily, and agree to be bound by its terms.
