Your physiotherapist whom you are seeing today is hoping to make video recordings of some consultations. The videos are to be used for training purposes as part of ongoing in-house professional development, and may also be used as part of promotional and marketing media.
The video is ONLY of you and the physiotherapist talking together. Intimate examinations will not be recorded and the camera will be switched off at any time if you wish. All video recordings are carried out according to guidelines issued by the Health Care Professions Council and the Chartered Society of Physiotherapy.
The recording will be securely stored and is subject to the same degree of confidentiality as your medical records. By default, the recording will be erased by three years, but you have the option to grant us to use material indefinitely as part of our promotional and marketing media.
The security and confidentiality of the video recording are the responsibility of the physiotherapist and Inform Physio. There is no proposed reason for the recording to be transferred to physical storage for sending, however if the recordings are to leave the practice premises in any format, it will be sent by registered post or Royal Mail Special Delivery, by personal messenger, or some other secure service.
You do not have to agree to your consultation with the physiotherapist being recorded. If you do not want your consultation to be recorded, please tell your physiotherapist immediately. This is not a problem, and will not affect your consultation in any way. But if you do not mind your consultation being recorded, we are grateful to you. If you wish, you may view the recording before confirming your consent.
If you consent to this consultation being recorded, please complete the form below. You have the right to withdraw your consent at any stage; for assistance with this, to request a copy of your consent or for any other concerns, please contact us at firstname.lastname@example.org.