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Patient Registration

Online forms to help you on your way 

Patient
Registration Form
Patient Pre-Injection
Questionnaire 
Patient Reg Form

Patient Registration Form

Please complete the form as accurately as possible

The information will be held confidentially in your medical records

Date of birth
Day
Month
Year

The clinician can only carry out a clinical assessment, treatment or procedure with your informed consent. Information will be provided on benefits & risks, or whether there are reasonable alternatives.


All appointments with the clinician are confidential; we can not disclose any information to any other person including your GP or other health care professional without your agreement.


During your appointment your clinician will take a verbal history, perform a physical examination& may discuss a treatment approach, which may be physical in nature.


Your consultation may require you to:

  • Undress to your underwear, shorts & vest

  • Perform physical tests

  • Be involved with physical contact with the clinician

  • Perform physical activity


Your treatment appointments:

  • Should relieve symptoms, however certain treatments may worsen symptoms prior to relieving them

  • It is not uncommon to feel an increase in pain or soreness later that day or the following day

  • If at any point you are concerned, please do not hesitate to contact us


During your appointment we want to ensure you are comfortable, you are welcome to:

  • Be accompanied by a friend, relative or chaperone

  • Patients under 16 must be accompanied by a parent/guardian at all times

  • Ask the clinician to stop treatment at any time

  • It is your duty to inform the clinician about any Medical Condition you suffer from

  • The clinician must be informed about artificial metallic implants including Pacemakers


If you have any questions at any point throughout the course of your appointment, please do not hesitate to ask.


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Pre Injection Q

Patient Pre-Injection Questionnaire

Please complete the form as accurately as possible

The information will be held confidentially in your medical records

Date of birth
Day
Month
Year

We recommend that you inform you GP that you will be attending for this consultation which may include an injection. (Local Anaesthetic, Cortico-Steroid, or Hyaluronic Acid)

Cortico-Steroid Injections may temporarily inhibit the immune response to the Covid or Flu vaccine. We are following guidance published by 'Arthritis & Musculoskeletal Alliance' which recommends a 2 week gap to ensure a full immune response. We are not able to perform Steroid Injections 2 weeks either side of a vaccination.

Medical History Checklist

Note: We recommend that patients with recent HbA1c above 8.5% (70mmol/mol) should obtain approval from their GP before booking. this related to Cortico-Steroid Injections only.

Steroid Injection may temporarily raise intraocular pressure, this can exacerbate POAG. If you have glaucoma or raised intraocular pressure or if you have suffered with visual disturbance after a steroid injection previously, you MUST discuss this with your GP before booking an appointment

Additional Relevant Information

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