CONSENT TO TREATMENT: I agree to participate to being assessed and treated by the physiotherapist. I understand that the assessment and treatment will be administered by the treating physiotherapist or, with my permission, his/her colleague. I acknowledge that my physiotherapist will give me all the information that is pertinent to my assessment and treatment, including the possible risks and side effects of the proposed treatment and that I will ask him/her all the questions I have regarding the treatment.

CONSENT FOR THE COST OF OUR SERVICES: I agree that I have been informed of the costs of R500 per treatment. This is to be paid upfront either in cash or via card machine.

CONSENT TO COLLECT AND DISCLOSE INFORMATION: Personal information that is collected by the SASP Physiotherapists working at Ironman Worlds may be retained and used to fulfill the following purposes: research, planning for future events. I fully understand that this is a legal requirement and that I have a choice not to consent to such information to be disclosed to any party. I confirm that I have exercised my choice voluntarily and that this declaration and exercise of my choices was not made under duress. I indemnify the Physiotherapist(s) working at World Ironman 2018 from any liability, damages or whatsoever that I may suffer as a result of this disclosure and that I may hold

LEGAL ACTION: I undertake that should any action be taken against the Physiotherapist(s) who treated me I will take action here in South Africa and that South African jurisdiction

DISCLOSURE REGARDING INJURIES: I shall inform the Physiotherapist(s) about the following current or previous injuries which could be aggravated by the treatment.and laws will apply. 

I hereby consent to physical assessment and treatment by the physiotherapists operating in this mobile clinic. My consent is voluntary and herewith I intend to consent to treatment for my entire stay whilst competing in Ironman 73.0 World Championships. I hereby consent to physical assessment and treatment by the physiotherapists operating in this mobile clinic. My consent is voluntary and herewith I intend to consent to treatment for my entire stay whilst competing in Ironman 73.0 World Championships.

CONSENT TO PHYSIOTHERAPY TREATMENT:

• During the treatment and evaluation I might need to uncover specific body parts and that I will be touched
• I may refuse to give consent for treatment or to be touched and can stop at any time when I feel uncomfortable
• I have been informed of all the benefits and risks of the procedures and/or modalities.
• I understand the possible potential complications and I have had the opportunity to discuss this with the physiotherapist.
• I give this consent freely and declare that it was not made under duress.

Informed Consent to Chiropractic Treatment,

I, Warning: Undefined array key "clientname" in /usr/www/users/tribicjnck/wp-content/themes/betheme/concent-form.php on line 327 , the undersigned, understand and declare that:

• During the assessment/treatment I may need to uncover specific body parts and I understand that I may refuse to do so if, and when I feel uncomfortable in doing so.
• The Practitioner will need to touch me in order, to assess and provide effective treatment and that I will inform the Practitioner if, and when I feel uncomfortable in doing so.
• It is my right to withdraw this consent at any time or for any specific procedure or modality.
• I have been informed of all the benefits and risks of the procedures and/or modalities.
• I understand the procedure/s and the possible potential complications and I had the opportunity to discuss this with the Practitioner.
• I consent to receive a Chirosport SA post-event questionnaire.
• I have given this consent freely and declare that it was not made under duress.
• I consent to Chirosport SA’s posting pictures of me on their social media platforms.