Precise Rehab Sdn. Bhd.
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Precise Rehab consent form
Datas collected will be used for medical & follow up purposes only.
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State the area/areas that you currently having problem/s at:
Slipped disc
Lower back pain
Sports injury
Work related injury
Muscle strain
Joint sprain
Neck pain
Shoulder injury
Tennis and golf elbow
Others
Closest branch location
Please select
Hartamas
Bangsar
Shah Alam
Bukit Jalil
Titiwangsa
Georgetown, Penang
None of the above
Physiotherapy Service Consent Form
I hereby declare that I am free from any serious medical conditions/ issues*:
*Surgical incision & Open Wound, Hypersensitive Skin, Healing Fracture, Acute Inflammation (Rheumatoid Arthritis), Cancer or Tumor, Osteoporosis (Advance), Diabetes (Advance), Deep Vein Thrombosis / Varicose Vein or any musculoskeletal injuries,
pregnant, taking blood thinning (or heamophilia disorder), using long-term steroids, immunosuppressant medication or have an implanted device.
Our team of physical therapists has undergone comprehensive training endorsed by GEMt DNT (Australia), specifically focused on the precise application of dry needling in conjunction with various manual therapy techniques.
I hereby provide my consent for the assessment and treatment processes as deemed suitable. I have been duly informed of the potential risks and advantages associated with the treatment and rehabilitation services. Furthermore, I willingly absolve PR PRECISE REHAB and its associates from any liability for damages that may arise as a result of the preceding treatment and rehabilitation services.
Necessity of physical contact and exposure of treatment area.
Authorizing the release of all necessary information
I would like a follow-up session
Register me!
Take a screenshot of the gift voucher to claim in the clinic!