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Consent
Please read each section and confirm your consent below.
Treatment Consent
Required
I understand that my physiotherapist will explain the proposed assessment and treatment, including the expected benefits, risks, and alternatives, before proceeding. I understand I can ask questions at any time and withdraw consent at any point — including during a session — without affecting my ongoing care.
I have read and understood the Treatment Consent information page, including my rights under the Code of Health and Disability Services Consumers' Rights.
AI-Assisted Clinical Notes (Heidi)
Your choice
We use Heidi, an AI clinical documentation tool, to help record and summarise your consultation. During your appointment, Heidi listens to the conversation between you and your physiotherapist and generates a structured clinical note.
What this means for you: Audio from your consultation is processed by Heidi Health (an Australian company operating under strict data security and privacy standards). The audio is used only to generate your clinical notes and is not stored long-term or shared with third parties. Your physiotherapist reviews all notes before they are saved to your record.
If you prefer not to use Heidi: Your physiotherapist will take written notes manually. Your care will be exactly the same either way. You can also change your mind at any time — just let us know at the start of your session.
Dry Needling
If applicable
Dry needling involves the insertion of fine needles into muscle tissue to reduce pain and improve mobility. It is only performed when clinically appropriate and always with your explicit agreement on the day. If your physiotherapist recommends dry needling during this episode, they will explain the process and risks before proceeding.
Known side effects include temporary muscle soreness, minor bruising, and (rarely) brief fainting. Serious adverse events are uncommon.
Pelvic Health Assessment
If applicable
For postpartum, pelvic floor, or women's health presentations, assessment may include internal pelvic floor examination. This is only performed when clinically indicated, fully explained in advance, and with your explicit consent on the day. You may decline and an external assessment will be offered instead.
Video & Movement Analysis
Optional
Movement assessment and exercise coaching may involve short video clips taken on a clinical device for the purpose of analysing your movement patterns. Footage is used solely for your clinical care and stored securely. It will not be shared externally without your separate written consent.
Payment Authority
Required
To hold your appointment we take a deposit when you book. Because we often cannot tell whether your treatment is ACC-funded or private until we have assessed you, we charge any remaining balance after your appointment.
- We store your card securely with our payment provider. House of Rehab never sees or stores your full card number.
- We will only ever charge you for appointments you have attended, or under our cancellation policy, which is set out in our Payment Terms.
- You will receive an emailed receipt for every charge, itemised.
- If a charge would be more than $[LIMIT — Patrick to confirm], we will contact you first rather than charging automatically.
- You can withdraw this authority at any time by telling us, and pay in clinic instead.
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Declaration & Signature
By submitting this form you confirm that the information you have provided is accurate to the best of your knowledge and that you have read and understood the consent items above.
If completing on behalf of a patient under 16, please provide the name of their parent or legal guardian.