Splint Consent

A splint has been provided based on a request from your referring doctor or clinical observations made at the time of the assessment. The splint may cause pressure in certain areas of the hand. Please contact your therapist immediately if you notice any of the following symptoms:

Pain of discomfort Redness of the skin

Do wear the splint for the advocated time

Do not attempt to adjust your splint yourself

Keep the splint away from direct heat e.g radiators, bath

Do make sure you attend the follow-up appointments, so that your splint can be checked to ensure it is doing its job effectively and necessary adjustments are made.

The splint may be cleaned with cool water and mild detergent e.g washing-up liquid

Dry the splint carefully with a soft cloth/tissue. Do not use a hairdryer

If you have been advised to wear the splint continuously, do not remove it for cleaning purposes. (Your therapist will clean the splint and your hand during your next appointment

I have been informed that there is a design & construction fee, splint measurement fee, thermoplastic fee and an additional cost for any other materials that are used such as Velcro, stockinette or padding. I hereby give consent to the above splint and have received an explanation of the reason for its use and the costs involved. Name (patient/parent/carer):

IF YOU HAVE ANY QUESTIONS REGARDING YOUR SPLINT, ASK YOUR THERAPIST

Robyn MidgleyBSc (Hons) OT, AHT (BAHT), ECHT (EFSHT) British Accredited & European Certified Hand Therapist

Achieving Clinical Excellence in Hand Rehabilitation