COVID-19 Consent Form

Patient Information and Consent Form

Risk of Coronavirus (COVID-19) Transmission at Maurice Lowe McTimoney Chiropractic

*This Form is in addition to consent form for chiropractic examination and treatment*

The Government published a Statutory Instrument on 26th March 2020, no. 350 ‘The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020’ confirming that it is lawful for a chiropractic practice to remain open. It further defines those people who are recognised as vulnerable for the purposes of document.

Maurice Lowe McTimoney Chiropractic has conducted a thorough risk assessment to ensure adequate levels of safety at this clinic are implemented and maintained. We are following the most up-to-date Government and Public Health England guidance and put in place stringent patient triage, hygiene, sanitation and infection control protocols to protect our patients and staff. Despite these precautions, there is a risk of transmission of the Coronavirus (COVID-19) and it is important that you understand the risk. We have provided the information below to help you decide if you wish to continue with your care at Maurice Lowe McTimoney Chiropractic and remind you that you are under no obligation to do so.

Precautions that Maurice Lowe McTimoney Chiropractic has in place:

  • All patients contacting us for an appointment are triaged by Maurice Lowe by telephone/ online form to establish whether symptoms are present, if they are self-isolating, if anyone in their household has symptoms or is self-isolating, they have recently returned from overseas or they have been in contact with anyone with COVID-19 symptoms and been asked to self-isolate by NHS Test & Trace.
  • We enforce a strict policy that anyone with any COVID-19 symptoms must stay away from the clinic
  • A second triage is conducted at the Clinic, including a temperature check
  • A strict cleaning, sanitation and infection control protocol is adhered to – Please ask if you would like to see this document 
  • All team members at Maurice Lowe Chiropractic adhere to the social distancing guidance issued by the Government
  • The layout of the practice has been adapted to maintain social distancing
  • Patients waiting are restricted to one at any time and a 2-metre distance will be enforced between patients and non-clinical team members
  • Chiropractors and Clinical Staff will be wearing Personal Protective Equipment for your protection
  • You will be asked to wear a face covering when attending the clinic

Maurice Lowe McTimoney Chiropractic is committed to ensuring that every measure is in place to minimise the risk of exposure to COVID-19, we cannot guarantee there is no risk to you as a result of attending the clinic.

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.

The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.  (World Health Organisation)

Clinically Extremely Vulnerable

From 5th November, the Government has asked people who are clinically extremely vulnerable to only leave home for exercise and attend healthcare appointments. At this time we are providing face to face appointments for patients in this group if you have an existing health condition, health concern or medical need.

Consent to receive care at Maurice Lowe McTimoney Chiropractic

  • I have answered all questions (triage) relating to my potential exposure to Coronavirus (COVID-19) truthfully.
  • I understand that there is a potential risk of transmission of Coronavirus (COVID-19) as a result of attending the clinic and/or receiving treatment.
  • I have had the opportunity to ask all the questions I wish to, and all my questions have been answered to my satisfaction.
  • I have read, agreed to and understood the statements above relating to Coronavirus (COVID-19) risk and consent to receive care at Maurice Lowe McTimoney Chiropractic
  • I understand and agree that I will need to give separate consent regarding my chiropractic care

For patients in the “Clinically Extremely Vulnerable” groups only:


    Covid-19 protocols continue to be in place – Please wear a face maskFind out more