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Form library · AH-001

Allied health consent to treat

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Rules differ by state; check yours.

Physio, chiro, podiatry and similar clinics taking consent before treatment.

The practitioner explains the assessment and treatment, its main risks and the other options before the person agrees. Consent can be withdrawn at any time. A parent or guardian can sign for a child. It is a consent form, not a treatment plan.

Physio and allied health at nopen

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Allied health consent to treat

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Example only. Fictional clinic: Example Allied Health Clinic, Subiaco.

DD/MM/YYYY

Privacy: Example Allied Health Clinic collects this information to provide your care. We may share it with the people who treat you. Read our privacy policy at example.com/privacy. Example only: the practice must write its own collection notice. See GEN-002.

Fields

  • Person

    Name and date of birth.

  • Signing for someone else

    Optional. A parent or guardian signs for a child.

  • Consent to treat

    A tick. The practitioner explains the assessment and treatment, its main risks and other options first. Consent can be withdrawn at any time.

  • Touch

    A separate tick. Treatment may involve touch, and the person can ask the practitioner to stop.

  • Health information

    A tick. The practice collects the health information on the form for care.

  • Collection notice

    A line the practice writes before anyone uses the form.

  • Signature

    Signed on the phone.

Questions

Does this cover every profession?

No. It is general. Your professional body may require more, so have it checked before use.

Can a parent sign for a child?

The blank has a field for it. The practice decides who may sign, against its own rules and the law in its state.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.