Informed Consent and Liability Waiver
Foundation Physiotherapy & Wellness uses promotional events to create awareness of their services including physiotherapy, massage therapy, chiropractic, manual therapy, and personal training. As part of these events, Foundation Physiotherapy will provide complementary services (of the above nature) for participants and attendees.
Services may consist of rehabilitative procedures, joint mobilizations, joint manipulation, massage techniques, exercises, cupping therapy, education, and physical agents. Procedures will be thoroughly explained to you before being performed.
Due to the nature of services provided, you may be asked to expose areas of your body for treatment. If this is necessary, your privacy, modesty, and dignity will be considered at all times by the therapist. Should you feel uncomfortable or embarrassed, you may refuse the procedure, stop the procedure and/or request another therapist (if available). There are certain inherent risks with physical therapy treatments because you will be asked to exert effort and perform activities with increasing levels of difficulty that could increase your level of pain or discomfort with a current or previous injury. You will be able to stop treatment if you feel any discomfort or pain. Your therapist will take every precaution to ensure that you are protected from any potentially hazardous situation. You will never be forced to perform any procedure that you do not wish to perform.
You understand that due to the nature of today’s encounter, it does not replace a formal physiotherapy, chiropractic, and/or massage therapy consultation. Any information, education, and treatment provided to you are based on your current presentation and symptomology. Today’s encounter is for promotional purposes only and is not intended to be used as part of any formal rehabilitative program.
By signing up below, I also consent to receive promotional material from Foundation Physiotherapy & Wellness. I am free to remove myself from promotional material at any time.
Based on the above information, I agree to participate in procedures. I have read the consent form and release Foundation Physiotherapy from any responsibility or liability due to my participation. If I have any medical conditions, I have consulted with my physician to make sure that physical and/or massage therapy is appropriate. I am fully aware that I am participating in this event at my own risk and will not hold Foundation Physiotherapy responsible in the event of my incurring an injury or exacerbating any previously existing conditions.