📝 Informed Consent — coMra Therapy (Generic / Reusable)
Patient Name: ___________________________
Date of Birth: ___________________________
Clinic: _________________________________
1. Purpose of Treatment
I understand that coMra therapy is being recommended to support my health condition. It may help improve tissue repair, circulation, nerve function, or comfort depending on my specific diagnosis.
2. What to Expect
I have been given the Patient Information Card that explains what coMra therapy is, why it may be used for my condition, what to expect during a session, and how my treatment plan may be adjusted to my needs.
3. Risks and Safety
I understand that:
- coMra therapy is considered safe, gentle, and non-invasive.
- It does not cut, burn, or heat tissue.
- Rare side effects may include temporary discomfort such as mild eye strain, headache, or fatigue, which usually resolve on their own.
- This therapy does not replace my ongoing medical care or medications.
4. Alternatives
I understand that alternatives may include:
- Standard medical management (medications, surgery, rehabilitation, or physical therapy depending on my condition).
- No treatment.
5. Voluntary Participation
I have had the chance to ask questions. My participation is voluntary, and I may stop treatment at any time without affecting my ongoing care.
Patient/Guardian Signature: ________________________ Date: ___________
Clinician/Witness Signature: ________________________ Date: ___________