New Patient Registration form

You will be seen by a fully qualified and registered Osteopath. The Osteopath needs to know about your health past and present. You will be asked detailed questons about your complaint, medical history, general health and any medication you are taking. You will be asked to perform simple movements to help the Osteopath understand your condition and further examination will be conducted while you lie on the examination couch. Osteopathy does involve undressing partially or fully down to your underwear and the osteopath will use his/her hands to examine and treat you.The Osteopath may take your blood pressure, reflexes, joint mobility and muscle strength. The Osteopath will make a diagnosis which he/she will discuss with you and in most cases some treatment will be given, but if the osteopath does not feel you will benefit from Osteopathic treatment, he/she will explain why.

I have read and understood the above (please tick)

Any advise or exercises will then be given at the end of the consultation. You may feel uncomfortable for the first 24 hours or so after treatment, but feel free to ring the osteopath/clinic.

I have read and understood the above (please tick)

In some clinical sitations the Osteopath may find it helpful to get / give details of your medical history to / from your GP. Further verbal consent is required and we will inform you before doing so.

Can we contact your GP?

I accept that I am responsible for payment of fees. If I fail to give notice for cancellation of an appointment within 24 hours. Or if I fail to attend. I will be liable for the cost of the consultation.

I have read and understood the above (please tick)

We are GDPR compliant. See the GDPR document:(Click Here) Your data and confidentiality is vital to us. We will not disclose your information to any other third party. We would like to contact you about the clinic, traffic, important information and health advice. To ensure smooth running we like to send appointment confirmation and reminder emails/texts.

I have read and understood the above (please tick)

I understand and agree to the above

I understand that a virtual appointment has some limitations. These will be explained in the appointment depending on my probable diagnosis. I may need a face to face examination to gain a clearer picture. A referral may be required. The Osteopath may have to be creative in using different objects to produce technique effects to help me. If I do not have a foam roller. I will purchase a foam roller and spikey ball to help in the future. I may also need therabands for rehab.

I understand and agree to the above.

Click to :See the GDPR document

COVID Screen Form Questions.

  • I have read the latest information. I am not in the High risk category.
  • No one in my household is in the high risk category defined by the above link
  • I have not had a high temperature, persistent cough or had loss or change to your sense of smell or taste in the last 14 days
  • I will not attend if anyone in my household has had any of the symptoms identified by the NHS link above within the last 14 days.
  • I will wait in my car until collected by my Osteopath. To reduce contact with other patients.
  • I will bring my own face mask. If I require one I will contact the clinic before my appointment with my Osteopath. (These can be supplied.)
  • I understand that on entry to the clinic I will wash my hands with hot soap and water for 20 seconds and dry on paper towels. I will use alcohol hand sanitiser on my way out.
  • I understand that Osteopathic Consultancy will be using anti-viral surfaces wipes to clean all surfaces that I come into contact with
  • The appointment will be a 1v1 with no one else in the clinic room
  • I understand that the Osteopath will be wearing PPE- Mask, Apron and Gloves
  • Osteopathic Consultancy will replace the pillow case each time and I will not have a plinth cover
  • I agree to these ongoing procedures for this and future appointments
  • I agree to notify Osteopathic Consultancy if I or anyone in my household gets COVID 19
  • I will avoid touching any surfaces when I am in the clinic
  • I understand that my Osteopath and myself may be infected with Covid-19. We are both taking appropriate precautions to safeguard against the chances of transmission
  • I consent to treatment from Osteopathic Consultancy and understand the risks of Coronavirus. I appreciate that all precautions are in place to minimise this risk
  • I have replied to this email to confirm these facts. I will reply to the email with 'I agree'
Please complete your medical screening details form so we can have a clear picture of you and your needs.