New Client Paperwork

Consent for Virtual Session​

• I understand that I am a client of Joanna Rose Physical Therapy, LLC and I will be participating in my virtual session via Telehealth format using a secure online platform. Even though Joanna Rose Physical Therapy, LLC utilizes a HIPAA secure telehealth platform, information sent over the internet may not always be secure. 

• I understand that the Telehealth sessions are hands-off sessions and will consist of detailed discussion regarding my condition, education on related topics, visual demonstration of common exercises or self-care strategies utilized for my condition. I am responsible for maintaining a safe working space around me during the telehealth session. 

• I understand that I may be given a home exercise program and advice to help me progress towards my personal goals. 

Informed consent:

• The term “informed consent” means that the potential risks, benefits and alternatives of physical therapy exercises have been explained to me. The therapist provides a wide range of services and I understand that I will receive information at the initial visit concerning treatments and options available for my condition. 

Potential benefits:

• I should gain a greater knowledge about managing my condition and the resources available to me. I may experience an improvement in my symptoms and an increase in my ability to perform daily activities. I may experience increased strength, endurance, mobility, and awareness of my body and movements. I may experience decreased pain and discomfort. 

Potential risks:

• I may experience an increase in my current level of pain or discomfort, or an aggravation of my existing injury or condition. This discomfort is usually temporary and sometimes a normal part of the process to progress; if it does not subside in a reasonable time period, I agree to contact my physical therapist. 

Payment: I understand that I am responsible for full payment for this session. Joanna Rose Physical Therapy, LLC is an out- of-network provider (cash-based services only).