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Consent to Assessment & Care Planning

I understand that my assessment and care will be provided by a licensed Chiropodist in accordance with the Chiropody Act (1991) and the standards and guidelines of the College of Chiropodists of Ontario.

I consent to:
✔️ A comprehensive assessment of my foot health, including a physical examination, medical history review, and diagnostic procedures as necessary.
✔️ The development of a personalized care plan based on the assessment findings.
✔️ A discussion of the recommended treatment options, including potential risks and benefits, before proceeding with any treatment.
✔️ Communication with me regarding my care and next steps.

I understand that:

• Providing accurate medical information is essential for safe and effective care.

• I have the right to ask questions and seek clarification at any time.

• This consent applies only to the assessment and care planning process.

• I will be asked for additional informed consent before any specific treatment is provided.

 

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Consent for Assessment & Care Planning

I consent to undergo an assessment by a licensed Chiropodist for the purpose of evaluating my foot health and developing a care plan. I understand that I will be required to provide additional consent before receiving any specific treatment.

Patient Name: 

Date: _______________
       

Signature: ___________________________

To be signed in person at your appointment.