By signing this form, you agree to the following:
I understand that the service offered is for the therapeutic purpose of general wellness, stress reduction, and pain relief.
I understand the risks associated with fascial therapy & applied neurology include, but are not limited to:
Skin redness
Short-term soreness
Exacerbation of undiscovered injuries
I have been given the opportunity to ask questions about fascial therapy & applied neurology and my questions have been answered to my satisfaction.
If I experience any pain or discomfort, I will immediately inform my therapist so that the pressure or techniques can be adjusted to my comfort level. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.
I have provided my therapist with accurate and relevant medical history and agree to inform my therapist of any new diagnoses, or changes in my health or medications.
I do not have any injuries or conditions that prevent me from exercise/mobility drills or receiving manual therapy. I understand the importance of informing my therapist of all medical conditions and medications that I am taking, and that there may be additional risks based on my physical condition.
I understand that I or the therapist may terminate the session at any time.
I release the therapist and business from all liability for any harm that may unintentionally result from this treatment.
I further understand that fascial therapy & applied neurology is not a substitute for a medical examination or treatment, and that I should see a physician or other qualified health specialist for any mental or physical ailment of which I am aware. I understand that the therapist does not diagnose illness or disease, and nothing said during the treatment should be construed as such. My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.
By signing this form I agree to the conditions as outlined above, and I release the therapist and business from all liability for any harm that may unintentionally result from this treatment.