Electronic Consent Form
Practice Name: Physio for You with Esther Dawson
Client Nme: ___________________________________
Date: ____________________________________
The purpose of this assessment is to evaluate your physical condition, understand your health concerns, and develop an appropriate treatment plan tailored to your needs. Your cooperation in providing accurate information is crucial to ensure effective care.
As part of your treatment process, detailed notes will be taken during assessments and follow-up sessions. These notes may include:
To assist with efficient and accurate note-writing, we utilize Heidi Health, a secure voice recognition software that ensures your records are an accurate reflection of your clinical sessions. These records are essential for ensuring continuity of care and will be used solely for the purpose of providing you with the best possible treatment.
Your privacy and confidentiality are of utmost importance. We adhere to strict guidelines regarding the handling of your personal information. The following measures are in place:
By signing this consent form, you acknowledge that you have been informed about the purpose of the assessment, and the nature of note-keeping, including the use of Heidi Health for record creation and Writeupp for record storage, and the confidentiality of your records. You give consent for the following:
Please confirm your consent by signing below:
Client Signature: _________________________________
Date: ____________________________________
Contact Information
If you have any questions or concerns about this consent form or the treatment process, please do not hesitate to contact us:
Phone: 07386111669
Email: physio4youwithesther@gmail.com
Website: www.physioforyouwithesther.co.uk
30-Minute Massage – A focused treatment targeting specific areas of tension, pain, or discomfort. Ideal for those needing relief from muscle tightness, stress, or minor aches in a particular area, such as the neck, shoulders, or lower back. A great option for a quick yet effective reset.
60-Minute Massage – A full-body or more in-depth treatment for chronic pain, muscle recovery, or deep relaxation. With physiotherapy-informed techniques, this session provides a comprehensive approach to relieving tension, improving circulation, and enhancing mobility. Perfect for those needing a longer, more therapeutic experience.
Both options benefit from expert physiotherapy knowledge, ensuring your massage is tailored to your specific needs for maximum effectiveness.
This comprehensive pelvic health appointment is designed for women experiencing a range of concerns, including pelvic floor weakness, diastasis recti (abdominal muscle separation often occurring after pregnancy), back pain, and hip pain. We’ll assess your posture, breathing patterns, core strength, and movement mechanics, often using external techniques. Depending on your specific needs and symptoms, an internal examination may be beneficial for a more thorough evaluation. We’ll discuss this possibility with you, ensuring you feel comfortable and informed every step of the way. Together, we’ll create a personalised plan involving exercises, manual therapy, and lifestyle advice to improve your function, reduce pain, and enhance your overall well-being.
We understand that some pain conditions are complex and require a more in-depth approach. To ensure we can thoroughly assess your needs and provide the best possible care, we recommend booking a complex initial consultation if you have multiple areas of pain, or if your pain has been longstanding or has a complex history. This will allow us to listen carefully and understand your unique situation. While a standard initial consultation may be sufficient for some, a complex consultation helps us avoid needing a second appointment and ensures we can address all your concerns from the start.
If you’re managing complex or multiple health concerns, our 90-minute Home Visit Complex Appointment is designed for you. We’ll take the time to thoroughly assess your needs and create a highly personalised treatment plan, all in the comfort and convenience of your own home. Experience in-depth care without the stress of travel.
Enjoy the convenience and comfort of a 60-minute initial assessment and treatment plan creation in your own home. Whether you’re short on time, prefer the familiarity of your own space, or simply want to avoid travel, our home visit option brings expert physiotherapy directly to you. Experience personalised care without leaving your front door.
Your 45-minute therapeutic massage (60 minutes including assessment) will be personalised to address your unique needs. We’ll start with a consultation to discuss your areas of focus, and then tailor the massage techniques to provide the most effective treatment for your body
Escape the stresses of daily life with a restorative yoga session. This practice focuses on deep relaxation and gentle stretching, using props like blankets, bolsters, and blocks to support your body in comfortable, passive poses.Restorative yoga helps to release tension in the body, calm the nervous system, improve sleep, and enhance overall well-being. All levels are welcome, no flexibility is required.
1:1 yoga offers a level of individualisation that’s simply not possible in a class environment. Whether you have specific injuries, limitations, or goals, your sessions will be designed to address them directly. We’ll work together to modify poses, explore variations, and create a practice that’s safe, effective, and perfectly suited to your needs.
Embark on your personalised yoga journey! This initial appointment begins with a thorough discussion and assessment of your unique needs and goals. Together, we’ll then design a custom yoga program tailored specifically for you. Follow-up sessions can be conveniently held in the comfort of your own home or at the clinic, whichever you prefer.
In this 50-minute follow-up session, we’ll implement the treatment plan we discussed and agreed upon during your initial consultation.
During this comprehensive 60-minute initial appointment, we’ll take the time to truly understand your concerns and goals. We’ll then partner with you to develop a tailored treatment plan, designed specifically to address your individual needs and guide you towards lasting results
Curious about how physiotherapy can address your needs? Schedule a free 15-minute telephone consultation. We’ll listen to your concerns and explain how we can help you achieve your goals