Patient Registration Form

Personal Details

Contact Details

Payment Details (Payment requested at end of consultation – thank you.)

Payment Methods

GP Letter/ Photographs

After your consultation our practice normally is to write to your GP for good communication.

We may take a photograph of your foot to keep on record as we find this very useful to record changes over time

Appointment Commitment

On making an appointment with us at TFH we are all agreeing to honour that commitment. At times things will get in the way and it will be necessary to reschedule appointments. We promise to give you as much notice as possible. We would request the same from you so that we can offer an appointment space to another patient. We very much appreciate your cooperation with this.

Use of Patient Information

To receive continuity and quality of care this information is recorded and may be shared with other members of the health care team involved in your care. We do not share your information with anyone who is not directly involved in your care.

Please Read and Sign to:

Confirm you understand our appointment confirmation.

Confirm the information you have provided is accurate and that you understand this information will be held securely to ensure safe and effective care.

Consent for Treatment

Podiatrists are legally and ethically obliged to obtain informed consent before the initial investigations or treatment. Within your initial assessment the podiatrist will discuss with you:

- a working diagnosis, prognosis, possible treatment options (including no treatment), risks and benefits and answer any questions you have

- You will be given time to consider the treatment options and what is suitable for you - Your consent can be withdrawn at any time

- A podiatrist may use sharp instruments and other equipment that may cause minor damage to the skin surface

Instructions on how to use the signature form:

On desktop - Simply hold down your left mouse button over the signature field. Touchpads on laptop devices should work in the same manner.

On mobile or touch screen devices - You can sign by simply using a finger on the signature field below

Take the first step to expert advice

Call us on 01722 340057 or request a callback