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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
Hartamas
Bangsar
Shah Alam
Bukit Jalil
Titiwangsa
Taman Sea, PJ
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 physical therapists have received extensive training under GEMt DNT (Australia) for the appropriate technique and use of dry needling in conjunction with other manual therapy techniques.
I consent with the proceedings of evaluation and treatment as deemed appropriate and I have been made aware of the risks and benefits associated with treatment / rehab services and agree to release PR PRECISE REHAB, and associates from all damages that may result from all respected treatment / rehab services:
Necessity of physical contact and exposure of treatment area.
Authorizing the release of all necessary information
I would like a follow-up session
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