New Patients - Consent Form
Emergency Contact Information
Your medical history
It is important that you answer these questions as honestly as possible to ensure you receive the best possible treatment. If you are not happy about any of the disclosure, please discuss this with your podiatrist, as these conditions or medications could have an effect when having an assessment or treatment.
Your GP's Information
Consent to being treated by a Podiatrist
Consent given is in light of full information of risk of failure or complication as well as alternative therapies available.
I understand that I am to be seen or treated by a Podiatrist
I confirm that I am aware that Podiatrists may use medical instruments
I confirm that I understand the cancellation or no show policy
Home Podiatry Ltd
359 Yorkshire Street
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