Patient Agreement

Assessment and Treatment

I understand that in order to provide me with the best possible care, a thorough assessment must be undertaken, including subjective and objective elements. I also understand that a physical examination will be part of the assessment and may include the physiotherapist observing me, assessing movement and strength and palpating me.

I agree to provide the information that is requested truthfully and understand that I can ask why the information is required.

Treatment may involve manual therapy (involving touch). It is likely that I will be required to complete some of my treatment at home, for example, activity modification, posture awareness, exercises. I understand that I will be included in any decisions made about my treatment and can request that it stops at any time.

Health and Safety

I understand that taking part in exercise, including specific exercise, general exercise and Pilates can involve certain risks. I am aware that having a thorough assessment (as above) allows appropriate exercise to be prescribed and risks minimised.

I understand that whilst completing exercise under the supervision of my physiotherapist I will be monitored to ensure that I am managing the exercise and if there are signs that I am not, the exercise shall be modified or ceased. I also understand that I am responsible for stopping any exercise if I feel I am not managing it, both when under the supervision of my physiotherapist and when exercising myself.

I understand that it is my responsibility to inform my physiotherapist if I develop any medical conditions or if there is any change in any of my existing medical conditions.

Data Protection and Privacy Notice

I confirm that I have read a copy of the Privacy Notice relating to Johnson Physio. I give consent for my personal information to be processed as described within the Privacy Notice relating to Johnson Physio.


I understand that payment for individual appointments will be due at the end of each appointment and agree to pay the specified amount for each type of appointment. Payments for Pilates/exercise classes will be due at the start of each month.

Cancellation Policy

I am aware that the cancellation policy for Johnson Physio is to charge 50% of the appointment fee if an appointment is missed or cancelled with less than 24 hours notice. I agree to pay this fee at my next appointment if I miss or cancel an appointment with less than 24 hours notice.