Consent to Physiotherapy Assessment & Treatment.

The Home Physio Service
Last updated: 27/04/2026

Clinician:
Nina Stuckey, Physiotherapist
HCPC Registered | CSP Member

1. About Physiotherapy

Physiotherapy may include:

• discussion of your symptoms and medical history

• physical assessment and movement analysis

• exercise prescription

• manual therapy (which involves physical contact), where appropriate

• education and self-management advice

• rehabilitation planning

Treatment is tailored to you and based on clinical judgement.
You may decline any part at any time.

2. Consent and Your Rights

Your consent is ongoing. It will be confirmed verbally at each session and documented in your clinical notes.

You have the right to:

• ask questions

• request changes to treatment

• stop treatment at any time

• request a chaperone

• have a chaperone recommended where appropriate

• receive clear explanations

Your comfort, dignity and safety are always prioritised.

3. Risks and Benefits

Potential benefits:

• reduced pain

• improved mobility, strength and function

• increased confidence

Possible risks (generally minor and temporary):

• soreness or fatigue

• symptom flare-up

• dizziness

• bruising (with manual therapy)

Mobility & Falls Risk

Some sessions may involve balance, walking, transfers or functional tasks.
These carry a small risk of loss of balance or falls.

All reasonable steps will be taken to minimise risk.
Please inform me immediately if you feel unsafe.

This does not apply where harm results from negligence or unsafe practice.

4. Capacity and Decision-Making

If there are concerns about your ability to provide informed consent, treatment will be provided in accordance with the Mental Capacity Act 2005, acting in your best interests and, where appropriate, involving family or carers.

5. Home Visit Safety

You agree to provide a safe environment, including:

• adequate space and cleanliness

• secure pets

• safe access

• appropriate supervision of children

Treatment may be withdrawn if the environment is unsafe (e.g. aggression, intoxication, unsafe conditions).

If a visit cannot proceed due to safety concerns, the full fee may be charged.

6. Communication

Email is password protected but not fully secure.
By using email, you understand these limitations. Alternative options are available.

7. Data Protection

Your data is handled in accordance with:

• UK GDPR

• Data Protection Act 2018

• HCPC and CSP standards

See Privacy Policy for full details.

8. Declaration

By signing, you confirm that:

• you understand the nature and purpose of physiotherapy

• you have had the opportunity to ask questions

• you understand the risks and benefits, including falls risk

• you understand treatment may involve physical contact

• you consent to assessment and treatment

• you understand home visit expectations

• you understand how your data is used

9. Signatures

Name: ___________________________
Signature: ________________________
Date: ___________________________

Clinician: ________________________