Patient Details

Service Description

Marylebone Diagnostic Centre provides:

• Shockwave Therapy

Treatment may include physical assessment, manual therapy, rehabilitation exercises, and shockwave therapy.

Important Information (Please Read)

• Shockwave therapy may cause temporary discomfort or soreness
• Results cannot be guaranteed and vary between individuals
• Temporary symptom flare-ups can occur
• Serious complications are rare

Medical Disclosure

I confirm that I have disclosed all relevant medical conditions, medications, implants, and allergies.

I understand that incomplete disclosure may affect treatment safety.

Data Protection & Confidentiality

Your personal and clinical data is stored securely in accordance with UK GDPR and MDC governance standards.

Information is shared only with authorised healthcare professionals involved in your care.

Electronic Declaration & Signature

By signing electronically, I confirm that:

• I have read and understood this consent form
• I had the opportunity to ask questions
• I voluntarily agree to the treatment described