Patient Registration – Posture Assessment

/Patient Registration – Posture Assessment
Patient Registration – Posture Assessment2018-11-04T11:31:37+00:00

Patient Registration – Posture Assessment

Gavin RoutledgeThank you for choosing active X backs. I’m delighted to welcome you. Our aim is to provide you with an accurate assessment of your posture and guidance on how to improve it. If you have any questions or concerns, please don’t hesitate to contact me at gavin@active-x.co.uk or on 0131 221 1415.

Please bring shorts to the appointment to wear during the assessment. In order to conduct a full postural assessment we will need to take two pictures of you in shorts and bare top (men) / bra or “boob tube” (women) – or you may wear a vest and roll it up to show your abdomen. This is so that we can see tops of shoulders, belly button, front of hip bones, knees and ankles.

Thank you very much for taking the time to register online. The below form is confidential and all information will be held in the strictest confidence by active X backs. Please fill in all appropriate fields as this information helps us greatly to manage your health and to run our business efficiently in order to deliver the best service possible. If you’re unable to register online prior to your first appointment, please arrive at the clinic ten minutes early in order to complete the form then.

We look forward to helping you to be active for life.

Warm regards,

Gavin Routledge
Clinic Director

Patient Information

  1. You will be seen by Gavin Routledge, a qualified osteopath registered with the General Osteopathic Council, who will be fully responsible for your clinical care.
  2. To help the osteopath understand and assess your posture, you will be asked to stand facing the camera for a picture and side on to the camera for another picture.
  3. Gavin will import the images into our software and analyse your posture, which he will then discuss with you.
  4. He will give you further advice regarding the improvement of your condition.
  5. Whether you have health insurance cover or not, you are ultimately liable for the cost of all treatment, services and items provided by active X backs and its agents.

CONTACT DETAILS

Including postcode

A BIT MORE ABOUT YOU

If applicable

CLINICAL

DATA PROTECTION AND PRIVACY OF DIGITAL IMAGES

For your safety and security, active X backs undertakes to:
- Store all images taken of you for the Posture Assessment solely on the hard drive of one PC.
- Delete images from our digital camera as soon as these images have been transferred to the PC.
- Ensure that the PC storing data will be password protected at all times.
- Ensure that no images will be downloaded from the PC other than for the production of reports solely for the patient concerned and that no copies of these reports will be made except with your express written consent.
- Ensure that the PC is part of a network protected by a physical firewall.
- Comply with the Data Protection Act.

CONFIRMATION & CONSENT

By submitting this form you are certifying that your answers are correct and confirming that you accept our terms as set out above.