I, ___________________________________________, have registered as a patient (hereinafter referred to as “Client”) with Anatomy360 rehabilitationhaving registered office at F/A-21A, Abul Fazal Enclave, New Delhi-110025.
I confirm that I have fully read, understood and agreed to comply with each of my obligations as a client listed below and adhere to, and be bound by, each of the following Terms and Conditions, before, during and after, availing any healthcare services (hereinafter “Sessions” or “Services”) from Anatomy360 rehabilitation:
I explicitly and specifically agree to the each of the following Terms and Conditions
- All Services at Anatomy360 rehabilitation are on Pre-Paid basis.
- Payments for any available medical services must be made in full and in advance.
- All payments are NON-REFUNDABLE and the plans are NON-TRANSFERABLE.
- Consent for restrictions under Anatomy360 rehabilitation “Plans” (defined below)
- Anatomy360 rehabilitation offers bulk payment options with additional benefits and/or extended durations and validity of services, which are called as “Plans”. Clients can pay for Plans in bulk or individually for each service session. The Plans benefits and conditions may change from time to time. All payments are NON-REFUNDABLE and the plans are NON- TRANSFERABLE.
- All sessions and services included in the Plan must be availed within the defined time period (VALIDITY PERIOD). Unavailed sessions, beyond the specified Plan period, will automatically lapse. The client will not be eligible to get any refund or extension of validity in such cases.
- In case of any medical emergency requiring you to extend the validity of the plan, please inform us immediately. An extension of upto 4 weeks only may be allowed in such exceptional circumstances. We reserve the right to allow such extensions of the plan period with/without payment, basis the incidental evidence provided by the Client.
- Bookings, Cancelations, Rescheduling and availing the services
o In case of cancellations, Clients are required to inform us atleast 12 hours prior to the appointed time to avoid being charged for the same. All pre-booked sessions (including pay per session) that are cancelled or rescheduled less than 12 hours prior to the appointed time slot will be considered as a ‘no-show’ and will be fully charged.
- Clients are required to value time and be ready for scheduled Consultations and Therapy sessions as per the appointed time only. Anatomy360 rehabilitation is unable to, and not liable to, offer compensating extra therapy time or reduced payment option or refund on account of shortened therapy time, caused due to late arrival or early departure of Clients or other factors that reduce the amount of time allocated for specific Services other than the therapist reaches late for the session.
- Please ensure that you behave professionally, cordially, respectfully and, are tolerant towards our staff and their services. At no time any manner of aggression will be tolerated by Anatomy360 rehabilitation. If the management team of Anatomy360 rehabilitation, at its exclusive discretion, concludes that any behaviour is not in compliance with the above-mentioned attributes, Anatomy360 rehabilitation at its exclusive discretion may forfeit current and future services and sessions without any refunds.
§ Informed Medical Consent for Services
· Anatomy360 rehabilitation has fully explained the following statements, terms and conditions of availing physical and rehabilitation therapy services from Anatomy360 rehabilitation.
· The purpose of physical therapy is to treat disease, injury and disability by examination, evaluation, diagnosis, prognosis, and intervention by use of rehabilitative procedures, mobilization, massage, exercises and physical agents to aid the patient in achieving their maximum potential within their capabilities and to accelerate convalescence and reduce the length of functional recovery.
· Response to physical therapy intervention varies from person to person hence it is not possible to accurately predict the response to a specific modality, procedure or exercise protocol. Anatomy360 rehabilitation does not guarantee what your reaction will be to a specific treatment nor does it guarantee that the treatment will help resolve the condition that you are seeking treatment for. Furthermore, there is a possibility that the physical therapy treatment may result in aggravation of existing symptoms and may cause pain or injury. It is very important to communicate with your treating physical therapist through your treatment.
· It is your right to decline any part of your treatment at any time before or during treatment, should you feel any discomfort or pain or have other unresolved concerns. It is your right to ask your physical therapist about the treatment they have planned based on your individual history, physical therapy diagnosis, symptoms and examination results. Consequently, it is your right to discuss the potential risks and benefits involved in your treatment.
· Following an initial comprehensive examination by a therapist, we will create an individualized training plan according to your goals and specific condition/limitations. You are required to be aware of the risks associated with this therapy. You shall not hold Anatomy360 rehabilitation or any of its staff responsible for any complications or untoward events that occur during the course of this therapy. As part of your therapy, the therapist may touch you to diagnose or treat your condition. It is an essential part of delivering the therapy services and is entirely based on the therapist’s judgement, which is necessary to deliver on your treatment or fitness objectives.
§ Consent
· I have read this consent form and understand the risks involved in physical therapy and agree to fully cooperate, participate in all physical therapy procedures and comply with the established plan of care. I authorize the release of my medical information to appropriate third parties.
· Further, by signing this form, I certify that I have read this form and I fully understand its contents entirely including the risks and my obligations and my responsibilities as well as my agreement to comply with the then prevailing Cancelation, Validity, Prepayment and other policies of Anatomy360 rehabilitation.
· I have been given ample opportunity to ask questions and that my questions have been answered to my satisfaction.
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· Name Signature Date