Thank you for consulting with us. It is important that you get to know and understand the salient
points of physical therapy. In addition, just like any other medical treatment, there are benefits
and risks involved in this treatment. We shall explain it also here in this informed consent and
you can also ask if you have further questions or you need clarification. We will answer and
explain them to you. Before a procedure shall be done, we will make sure to explain them to you
first.
Please note that you have the right to decline any part of the treatment before or during
treatment. You have the right to ask your physical therapist about the treatment plan and discuss
the potential risks and benefits of the treatment.
What is Physical Therapy?
Physical therapy is a rehabilitation method that helps patients gain or regain their physical
activities that they lost or that they are incapable of doing due to defects either from birth or
resulting from injuries or disease. There are various methods of treatments to help one to regain
and/or improve his or her physical function.
How Physical Therapy is Done
Physical therapy is often done with the help of guided exercises. Some use additional agents such
as heat or cold compress, sound waves, electricity, or mechanical devices or machines. This will
depend on the issues that are needed to be addressed and the technology available for the
physical therapist to utilize.
The Risks
As physical therapy intends to resolve the problem that the person is experiencing due to illness
or injury, there are some risks that may arise during the course of the treatment such as pain and
discomfort during the process of therapy. Stretching and twisting may cause some swelling and
soreness of stiff muscles. This is normal. There are therapies that may use hot or cold compresses
in order to relieve the pain during therapy. Your physician may prescribe drugs in order to help
you with the pain and swelling while going through the process of physical therapy.
Please take note that some can experience pain and discomfort that may reduce one's motivation
to continue due to pain or lack of manifesting results. It is important that the person continues
with the therapy if it is too early to conclude the results. It would be best to discuss these matters
with your physical therapist.
Expectations
There are no guaranteed expectations when one undergoes physical therapy treatment. This
depends on the situation. But when one undergoes a physical therapy program, it is intended that
one will be able to return to his or her prior level of functioning or develop a method to continue
what was possible to be performed before the injury that is no longer possible after being
permanently injured. Physical therapy When going through the program, it is important that the
patient is truthful with what he or she thinks or feels. Proper communication is important for the
progress of the patient.
Fees and Schedule
One session is for about 1 hour and each session is by appointment. You can call/text(602)
975-3973 to schedule an appointment. Each session is $150. You may purchase a package of 10
sessions for 10% off. If you wish to purchase additional sessions after you have used all of your
packaged sessions, you can buy another package, or individual sessions at the normal $150 rate.
Payment is required at time of service, and package payment is required prior to first session of
the package. If you wish to submit for out-of-network reimbursement, a superbill will be
provided free of charge.
A $25 fee will be charged to each treatment hour for in-home visits if the location of treatment is
more than 30 minutes away from the 32nd Street and Indian School intersection of Phoenix, AZ.
Sessions at BlakSteel Fitness are $150 for one hour, and $80 for 30 minute follow ups (initial
evaluation must be one hour).
Cancellation Policy
Please provide 24 hour notice if you wish to cancel your appointment. Because we schedule one
hour (plus travel time), cancellations can have a big impact on other patients' ability to get an
appointment. A cancellation fee of $100 will be charged for any appointment cancelled without
24 hour notice.
Confidentiality
Under the Healthcare Insurance Portability and Accountability Act of 1996 (“HIPPA”), we are
required that all medical information of every individual be kept securely and shall not be
disclosed to anyone. This allows the patient to have the right on how his or her information and
how it shall be used.
The records we acquire from you shall be used for managing health care by health care providers
and will be used for reference for payment or reimbursement for services such as billing or
collection. We may also use your information for the assessment and improvement of our
activities and business operations.
Consent
I have read all the information provided here or it has been read to me. I understand the contents
of this informative consent form. I understand the risks involved in physical therapy and agree to
participate in the procedures to be conducted and comply with the established plan of care set
forth by my physical therapist. I have had the opportunity to ask questions and all of which were
answered to me accordingly.
