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Forge Lab Physiotherapy Booking Form

Personal Information

Full Name

Phone

Email

Date of Birth

Emergency Contact

Emergency Contact Phone

Medical Information

Chief Complaint/Diagnosis

Please specify

Booking Information

Which Clinic Would You Like to Book?

Type of Service

PRICELIST

Preferred Date

Preferred Time (1hour)

Please Read Patient Waiver & Consent

1. PATIENT CONSENT & WAIVER

By checking the box below, I confirm that:

I am seeking physiotherapy treatment at Forge Lab Physiotherapy Clinic of my own free will.

I understand that physiotherapists do not provide medical diagnoses and that treatment is not a substitute for medical consultation.

I accept the possible risks (such as temporary soreness or discomfort) and take full responsibility for choosing to proceed without prior medical clearance.

I release Forge Lab Physiotherapy Clinic, its owners, and staff from any liability related to my voluntary participation in treatment.

2. DATA PRIVACY WAIVER & CONSENT

By checking the box below, I confirm that:

I consent to Forge Lab collecting and processing my personal information (such as name, contact details, and other details I provide) for the purpose of confirming my booking and delivering services. My data will be kept confidential, used only for these purposes, and will not be shared with third parties unless required by law. I understand I may request access, correction, or deletion of my data by contacting Forge Lab Inc.

Waiver and Consent

I Agree to Forge Lab Inc.'s (1) Patient Consent & Waiver and (2) Data Privacy Waiver & Consent