Rochdale Valiant in Defeat Against Promotion Hopefuls Richard Bradley 1st XV Match Reports October 5, 2026
Late Vale Fightback Breaks Rochdale Hearts in Thrilling Contest Richard Bradley 1st XV Match Reports September 29, 2026
RRUFC Physio Medical Information & Consent FormFirst NameLast NameAddressAddress Line 1Address Line 2TownPostcodeEmailDate of BirthNext of Kin & Contact NumberMedical DetailsAny problems will be discussed with your physiotherapist in more depthDo you have any heart problems?– Select –YesNoDo you have a cardiac pacemaker? – Select –YesNoDo you have high/low blood pressure?– Select –YesNoDo you have any breathing problems (e.g. asthma/bronchitis)?– Select –YesNoHave you ever taken steroids?– Select –YesNoDo you have diabetes?– Select –YesNoDo you suffer from epilepsy or seizures?– Select –YesNoHave you ever had anticoagulant therapy (i.e. Warfarin/Aspirin)?– Select –YesNoHave you ever been diagnosed with cancer?– Select –YesNoAre you pregnant? (LADIES ONLY!)– Select –YesNoAre you taking any regular medication? If so, please list:Have you any allergies? If so, please list:CONFIRMATIONIF AT ANY POINT YOU DEVELOP ANY ILLNESS IT IS YOUR RESPONSIBILITY TO TELL THE CLUB MEDICAL STAFF IMMEDIATELY. PLEASE READ CAREFULLY ON SIGNING THIS FORM I HEREBY CONSENT TO RECEIVING PHYSIOTHERAPY/ MEDICAL ASSESSMENT / TREATMENT.This may include: Initial assessments, Treatment (Hands on Techniques , Electrotherapy, Massage), Tests (X-ray, scan, hospital referral) THIS LIST IS NOT EXHAUSTIVE AND ANY INTERVENTION WILL BE THE DECISION OF THE HEALTHCARE PROVIDER EMPLOYED BY RRUFC I confirm that all of the information I have given on this form is correct to the best of my knowledgeSubmit Form
