New Patient Registration – Skype Consultation

Back Pain and Sciatica

Gavin Routledge

Thank you for requesting an online consultation. I’m looking forward to helping you further.

The code of practice of the General Osteopathic Council requires each osteopath to enter into a one-to-one contract with their patients in the form below. If you have any questions or concerns in connection with the contract treatment, please don’t hesitate to email us back at info@active-x.co.uk.

Thank you very much for taking the time to register. 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 me greatly to offer you the best advice.

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

Warm regards,

Gavin Routledge
Clinic Director

Patient Information

  1. You will have a Skype consultation with Gavin Routledge, a qualified osteopath registered with the General Osteopathic Council, who will be fully responsible for your care.
  2. The consultation may last up to 40 minutes and you agree to pay £89 in advance for this.
  3. The osteopath needs to know about your past and present health and you will be asked detailed questions about your complaint, medical history, general health and any medication you may be taking. You agree to provide this information.
  4. If you have any concerns at any time during the consultation, you agree to ask the osteopath to stop and explain anything you are unsure of.
  5. To help the osteopath understand and assess your condition, you may be asked to explain your physical condition in detail. You agree to comply with this process.
  6. The osteopath will make an evaluation, which he will discuss with you, and will give you further advice regarding the management of your condition.
  7. You are liable for the cost of all services and items provided by active X backs and its agents.

CONTACT DETAILS

Including postcode
We need this and will contact you to set up the call.

A BIT MORE ABOUT YOU

If applicable

CLINICAL 1 - When we have our call, I want to spend as much time as possible assessing your problem and providing advice. Please answer the questions below to give us a head start.

CLINICAL 2 - You're nearly there, we just need a few more details about your problem...

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.