Please fill out the form below to make a booking or enquiry. Harpenden Home Physio will get back to you shortly, thank you. 

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Booking form

 

COVID Declaration

Please fill out the following health declaration form within 24 hours of your appointment. 
Have you been in contact with or been advised to self-isolate with COVID-19 symptoms in the last 14 days?
Are you experiencing any of the following in the last 14 days: A new continuous cough, a high temperature or anosmia (a loss of or change in your normal sense of smell or taste?
Have you or anyone in your household returned from anywhere outside of the UK in the past 14 days?
Are you in a high risk group for COVID-19 and have been asked to shield by your GP?
Do you consent to face to face treatment in the full understanding of the risk of contracting COVID-19 and understand that every precaution has been taken to avoid contamination?

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Consent Form

Please fill out the following consent form within 24 hours of your appointment. 
Do you consent to physiotherapy assessment and treatment as deemed appropriate by the Harpenden Home Physiotherapist?
Are you aware that I can withdraw consent for further treatment at any time?
Are you aware that I can withdraw consent for further treatment at any time?
Do you understand that you are responsible for the prompt payment of all assessment and treatment received?
Do you understand that missed appointments and appointments cancelled with less than 24 hours’ notice may incur a cancellation charge of 50% of a treatment fee, unless a valid reason is given?

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If you are unable to fill out the above COVID or Consent forms - please print and sign the 2 forms below and have them ready for your physiotherapy appointment - thank you. 

Harpenden - St Albans - Wheathampstead -Redbourn - Sandridge- Caddington - Luton