Consent Authorization Form - Adults - SPOT Children's Therapy Centre

Company

这个字段是用于验证目的，应该保持不变。

请仔细阅读。

您的详细信息

Your name*

电子邮箱*

Your Date of Birth*

I hereby consent to receiving therapy intervention at SPOT as deemed appropriate by the therapist team.*

是
否

本人确认并同意取消政策*

如需取消预约，必须提前24小时通知治疗师或提供医生证明，否则将收取全额费用。（完整取消政策详见官网）).

是
否

I understand that SPOT therapists participate in regular confidential clinical supervision in order to support best practice and continuing professional development. I understand that my case may be presented in supervision within the bounds of confidentially.*

是
否

SPOT中心有限公司使用悬挂式设备进行移动、攀爬及平衡训练，旨在为儿童提供有益的治疗体验。治疗师始终以最高标准谨慎操作以降低风险。与任何室内游乐场环境相同，尽管配备缓冲垫、护垫、防护垫及成人监督，使用游乐设施和健身器材仍存在风险。降低风险的关键在于：请务必及时告知治疗师孩子健康状况、用药情况或家庭环境的任何变化，特别是可能影响反应速度和运动控制能力的因素。

I have fully read the above statements and understand the inherent risks involved during activities using the SPOT equipment. I hereby release SPOT Centre Ltd owners and employees from any liability, claims, demands and causes of action, nor or in the future, resulting from soreness or injury however caused, occurring during or after my participation in therapy.*

是
否

I would like to receive the monthly e-newsletter from SPOT.*

是
否

I authorise SPOT therapists to photograph/video me for the sole purpose of keeping clinical records.*

是
否

I authorise SPOT therapists to liaise with other professionals who are also involved in my therapy and learning. (Please list below)*

是
否

Other Therapists

Please note name(s) and contact details of other therapist(s) and educator(s):*

姓名	Contact Information

签名

签名*

请在框内使用鼠标或触屏设备手指签名。

Consent Authorization Form – Adults

您的详细信息

Other Therapists

签名

预约

SPOT 中环

SPOT 黄竹坑

SPOT 愉景湾

SPOT 九龙湾

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