CONSENT FORM

The physiotherapist will sit down and talk to you about your performance and the physical results of test. The test gives you a Yes/No result. The result tells you if you are ready to participate in sporting, recreational and work activities. A ‘Yes’ indicates you are ready. A ‘No’ indicates that you are not yet ready to return to activity. You and your physiotherapist and surgeon will be given guidance on the rehabilitation you need to focus on, to improve the strength and function of your knee.

Project title: Anterior Cruciate Ligament reconstruction re-injury prevention testing program (RIPT)

I have read and understood the information provided about this project in the Information Sheet titled Anterior Cruciate Ligament reconstruction re-injury prevention testing program (RIPT). I have had an opportunity to ask questions and to have them answered. I understand that I may withdraw myself or any information that I have provided for this project at any time prior to completion of data collection, without being disadvantaged in any way. I am not suffering from heart disease, any respiratory condition (mild asthma excluded), any infection, any illness or injury that impairs my ability to participate in this study. I am not pregnant. I have had no recent spinal, appendicular or abdominal surgery that may impair my ability to participate in this study. I agree to take part in the Reinjury Prevention Test and have my data collected. This data includes details of my surgery and rehabilitation and the results of the test. I understand that the data will be collected, but that it will be made anonymous. I understand that as with any physical test there is a small risk of injury

    Please fill out the form on the previous page.