ConchyMan's Tele-Rehabilitation

Worldwide Tele-Rehabilitation Services

Agreement Information

ID:

Date:

Time:

Independent Physiotherapist Registration & Service Agreement

1. Personal Details

Full Name

Date of Birth

Gender

Blood Group

Aadhaar / Passport Number

Qualification

Registration Number (Council)

Father's / Husband's Name

Full Address

Phone Number

Email ID

2. Banking Details

Account Holder Name

Bank Name

Account Number

IFSC Code

UPI ID / Mobile Banking ID

3. Agreement Terms & Conditions

1. ConchyMan's Tele-Rehabilitation acts as a tele-rehabilitation platform connecting patients and independent physiotherapists. Therapists are individually responsible for maintaining valid professional licenses, registrations, and legal authorization required in their country of practice.

2. The Physiotherapist confirms that he/she is legally authorized to practice physiotherapy in the country from which services are provided and accepts sole responsibility for compliance with local licensing and professional regulations.

3. The Physiotherapist is engaged as an Independent Service Provider and not as a permanent employee, agent, partner, or representative of ConchyMan's Tele-Rehabilitation.

4. For every consultation conducted through ConchyMan's Tele-Rehabilitation, 25% (twenty-five percent) of the consultation fee shall be retained by the Platform Owner as administrative and operational charges. The remaining 75% (seventy-five percent) shall be payable to the Physiotherapist.

5. The Physiotherapist shall submit all consultation records, receipts, treatment notes and patient files at the end of each calendar month.

6. Payments shall be processed within seven (7) working days after verification of submitted records.

7. The Physiotherapist shall maintain complete confidentiality of patient information and shall not disclose patient records to any third party without lawful authorization.

8. The Physiotherapist agrees to:
  • Follow ethical physiotherapy practice.
  • Maintain professional behavior.
  • Follow applicable healthcare regulations.
  • Use evidence-based treatment methods.

9. Tele-rehabilitation services are advisory in nature and may not replace emergency or in-person medical care when clinically indicated.

10. Either party may terminate this Agreement by providing thirty (30) days written notice.

11. This Agreement may be executed electronically. Digital signatures, electronic acceptance, typed names, and electronically submitted copies shall be considered valid and binding to the extent permitted by applicable law.

4. Declaration

I hereby confirm and declare that:
• The information provided in this Agreement is true, complete, and accurate.
• I possess valid and current professional qualifications and registrations.
• I have read, understood, and agree to all terms and conditions of this Agreement.
• I understand and accept the revenue-sharing policy (75% therapist / 25% platform).
• I am legally authorized to practice physiotherapy in my country of practice.

Physiotherapist Signature

Full Name

Upload Signature Image

Upload Signature Here

Date

Electronic Signature Confirmation:
• I acknowledge that my typed name above serves as my legally binding electronic signature.
• I confirm that I have read all terms and conditions of this Agreement.
• I agree that this electronically submitted document is equivalent to a physically signed paper document.

Electronic Execution Notice: This Agreement may be executed electronically. Digital signatures, electronic acceptance, typed names, and electronically submitted copies shall be considered valid and binding to the extent permitted by applicable law. Each party shall retain a copy of this executed Agreement for their records.