Consent to Treat

  • I hereby consent to voluntarily engage in physical therapy treatment and services deemed necessary by my physical therapist and/or physician. I understand that physical therapy is not an exact science and I acknowledge that no guarantees have been given to me as far as my treatment.

  • By typing your name in the space below you are providing an "electronic signature" and it indicates your approval of the information contained in this electronic form.
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.