INFORMED CONSENT AND WAIVER
· I consent to receive physiotherapy, holistic life coaching services and/or nutritional therapy from Absolute Potential Health & Performance including an assessment to determine the appropriate treatment to meet my specific needs and goals. I understand that my physical treatment may involve the use of:
- Various physical modalities eg. electrical stimulation, taping
- Dry needling
- Manual therapy, stretching, soft tissue massage and/or mobilisations of joints and tissues
- Exercise programs aimed at mobility, strength and function which may include corrective stretches, resistance training and/or postural exercises
- Dietary supplementation that may include vitamins, minerals and nutraceuticals
· I understand that any recommendations regarding diet and lifestyle modifications are given to the best knowledge of the therapist and do not replace a medical doctor’s treatment. I agree that I will discuss any changes to existing medications and/or treatments with my treating doctor and do so of my own free will
· I have been informed and understand that physical exercise has been associated with certain risks, including but not limited to musculoskeletal injury, spinal injuries, abnormal blood pressure responses and in rare instances, heart attacks or death. Every effort will be made to minimise these risks.
· I understand that discomfort and/or aggravation of symptoms may occur following treatment. I understand that it is my responsibility to inform my therapist should I experience any unusual symptoms.
· I understand that if at any time I am not comfortable with, and/or do not understand the purpose of any treatment procedure I will ask the therapist for further explanation/information. I understand that I may stop the assessment or treatment procedure at any time, during or after a session.
· I fully understand that all corrective health, strength and performance programs and dietary advice are designed with my health and wellbeing and with my utmost safety in mind. In the event that I may injure myself as a result of my participation in this program, I hereby release, discharge and waive any and all responsibility of Sissy Taufika and Absolute Potential Health & Performance now or in future.
· Due to the limited availability of appointments, appointments that are missed or cancelled with less than 24 hours notice will be charged at full price. This fee may be waived should the appointment be able to be replaced by another client or under special circumstances at the discretion of the therapist. I fully understand that if I miss or cancel an appointment without 24 hours notice, I will be charged the full appointment price.
· I have read, understood, and had the opportunity to discuss the initial contact form.