Consent for Assessment and Treatment of Sensitive Areas

have requested assessment or treatment by Osteopath

For treatment of the clinically relevant areas indicated below:

The Osteopath has explained the following to me and I fully understand the proposed assessment or treatment:

• The nature of the assessment, including the clinical reason for assessment of the above area and the draping methods to be used.
• The expected benefits of the assessment or treatment.
• The potential risks of the assessment or treatment.
• That consent is voluntary.
• That I can withdraw or alter my consent at any time.

I voluntarily give my informed consent for the assessment and treatment as discussed.