Kelly Alhooie walks through a consent form template for cash-based pelvic health practices. The form covers cancellation policies (24 or 48 hours), treatment pricing disclosure, dry-needling fees ($15 per session), pelvic floor exam risks, telehealth consent, and photo/video use. Consent forms inform patients but don't provide legal immunity.
Chapters
All right, guys. So now I'm gonna go with consent form. So anything that's highlighted, please take that out and put your practice name in there. These are policies that we have in place to make sure that patients are consistent and comes in, comes in. So we We have a 24-hour cancellation policy in here to make sure that patients are just not canceling and all of a sudden we can't fill a schedule and then we have to pay a provider and we can continuously do that and run a business. So yes, we get that, you know, things happen, emergencies happen, we get that, but we've got to hold the patient accountable to being consistent every single week and this is how we do it. So we have a 24-hour cancellation policy. Some people even have a 48-hour cancellation policy. That is up to your discretion. We also put in here, per that new act of where we have to, you know, show what our treatment price is. We also put that in there. So make sure you just change that to whatever you are charging. Hopefully you're charging at least over $200 or above. It's kind of nationally the standard there. And then what else? Can we collect your information? Again, cancellation policy here. If you're late to your appointment, what happens? That way they know. And then dry needling. So we have a dry needling consent form. So we charge an extra $15 per, you know, time we dry needle. You could also include that in your price, just raise your price, and then you don't have to charge an extra $15. But, you know, that is something that we just want to make them aware of. Pelvic floor patients. What are the risks potentially associated with pelvic— having a pelvic floor exam? What could or cannot happen? Um, telehealth session, what that looks like as well, the benefit to that, the risk to that, that it will be recorded. Um, photo consent, if you want to take pictures for your Instagram or, um, you know, put it on your website or whatever else, then here's a photo consent as well. Um, also potentially if you want to film HEP, their exercises and you want to use their phone. Even with that, you still want to make sure the stuff's signed. So please, you can pick, choose, change, whatever from here. But here's an example of consent forms. Now let me just state this, per my many lawyers, consent forms just basically state, um, that they are aware of the risk that could happen by doing whatever procedure or going with whatever issue. Consent forms do not protect you if you were to go to court and they're— and then you'll be like, well, they signed a consent form. No, that means they're— you're just stating and making them aware of the risk of doing a dry needling procedure. You're making them aware of the risk of doing an internal exam. That's all a consent form is. It doesn't protect you against anything. Any claims that anyone can make. So just FYI, I didn't know this when I first started out. So consent forms are just used to make you aware of the risk. That's it. So hopefully that helps. But you want to make sure definitely people sign it to make sure that they are understanding, you know, the process and how things work.
