Client Disclaimer - Pre-Treatment

 

'By completing the above Informed Consent form and signing below, you acknowledge and agree: (i) that Body Maintenance Centre does not accept responsibility for lost, stolen or damaged valuables, cash or personal items; (ii) to abide by the rules of and follow any directives of Body Maintenance Centre and any facility where Body Maintenance Centre provides its services to you (Facility) at all times; (iii) that you have voluntarily engaged the services of Body Maintenance Centre and you are making use of the services Body Maintenance Centre provides and accessing and using the Facility of your own free will; (iv) that you have provided all relevant information regarding your medical history and the current status of your health and any current medical conditions to Body Maintenance Centre. (v) that all information that you have provided to Body Maintenance Centre is complete and accurate to the best of your knowledge. (vi) that you grant permission for Body Maintenance Centre and its affiliated network partners the right and consent to the use of video footage and photographs of yourself for marketing purposes only for example such purposes as publicity, print illustration, web content and online advertising. (vii) that, if relevant, this Informed Consent form (including this Disclaimer) extends to any hydrotherapy or manual therapy services provided to you by Body Maintenance Centre and any reference to ‘Facility’ includes any pool from which Body Maintenance Centre provides its hydrotherapy or manual therapy services to you; (viii) that, if you have provided your credit card details to Body Maintenance Centre, you authorise Body Maintenance Centre to input those details into its online practice and patient management software (currently Halaxy & Trainerize) on the basis those details will then be stored electronically by its online practice and patient management software to pay future invoices issued to you by or on behalf of Body Maintenance Centre for services provided to you and in doing so, you authorise the payment of such invoices using those details, you acknowledge and agree that Body Maintenance Centre simply inputs the details into its practice and patient management software and that it is not responsible or liable for the storage, processing or transmitting of such details and you accept the Payment Processing Terms of Body Maintenance Centre’s practice and patient management software which are available to view at https://halaxy.com/article/terms. (ix) that the services that Body Maintenance Centre provides and your access to and use of the Facility involve a degree of risk, including physical and non-physical harm to yourself, and that you have voluntarily chosen to participate in the services that Body Maintenance Centre provides and access and use the Facility, accepting that the materialisation of such risks may cause personal injury, death or property damage. (x) that exercise or physical activity is physically demanding and may pose a risk to your health and you accept such risk; (xi) that you forever release and discharge Body Maintenance Centre (and all of its contractors, employees, directors, officers, affiliates, subsidiaries, related parties, agents, successors and assigns) and the Facility from any and all claims, actions, suits, demands, damages, interest and costs arising out of or as a consequence of any services provided by Body Maintenance Centre or your access to and use of the Facility (Claims) for any loss, damage or injury to person (including yourself) or property whether caused by negligence, wilful act or omission, accident, another person or however otherwise caused; and (xii) that you forever indemnify Body Maintenance Centre (and all of its contractors, employees, directors, officers, affiliates, subsidiaries, related parties, agents, successors and assigns) and the Facility against all Claims for any loss, damage or injury to person (including yourself) or property whether caused by negligence, wilful act or omission, accident, another person or however otherwise cause.

 

Duty of Care: As part of our ‘Duty of Care’ the following information will notify you of any risks associated with professional Physiotherapy treatment techniques. Such techniques used including massage, myofascial release, traction & joint mobilisations have a very small risk of causing injury.

 

A remote possibility of injury to structures such as but not limited to; nerves, bones, muscles, ligaments, discs or arteries exist. Allergic skin reactions to massage oils, strapping tapes or topical applications are a possibility. Massage techniques could possibly lead to minor bruising depending on medications, additional co-morbidities or other physiological factors.

 

Following the verbal explanation of my examination results and the therapeutic techniques the therapist decides to suit my condition; I give my consent to treatment. I have the right to decline treatment that the therapist offers me at the time. I have the right to a second opinion at any time.

 

I give permission to the therapist to exchange information with my doctor and other medical specialists, as well as teachers/coaches/trainers when necessary, unless otherwise notified. I understand that this information will be confidential.

 

Additionally, I take responsibility to notify my therapist of any infectious diseases that I am aware of and may be carrying (i.e. TB, HIV, Hepatitis, Glandular Fever, Golden Staph), as I understand the manual handling techniques mentioned above will enhance the possibility of contracting this/these diseases.

 

In relation to Medicare Chronic Disease Management Plan’s bulk billed sessions, if claim is denied from Medicare due to various circumstances, the balance will be paid out of pocket by the patient to Body Maintenance Centre.

 

Additionally, the patient must notify Body Maintenance Centre at least 24 hours prior for any cancellations or rescheduling of appointments otherwise a fee may occur depending on the circumstances.