NormaTec Compression Therapy Waiver Logo
  • NormaTec® Compression Therapy

    Liability Waiver
  • Physical Capability Requirements

    Participation in a NormaTec® Compression Therapy session involves exposure to vasopneumatic compression for a short period of time.  During the compression therapy, a Health & Wellness practitioner will be present.  You are free to terminate the session at any time.

    Contraindications

    NormaTec® Compression Therapy is contraindicated for patients with:

    • Current or unstable fractures/breaks
    • Recent surgery and have sutures/stitches
    • Open wounds, contusions, abrasions
    • Suspect or known Acute deep vein thrombosis (DVT) (Blood clot)
    • Severe artherosclerosis (disease of the arteries)/Ischemic vascular disease (IVD)
    • Severe congestive cardiac failure (CHF)
    • Existing pulmonary edema (having excess fluid in the lungs)
    • Existing pulmonary embolism (blood clot in the lungs)
    • Extreme deformity of the limbs
    • Any local skin conditions such as gangrene, untreated or infected wounds, recent skin graft, or dermatitis
    • Know presense of malignancy in the legs or arms
    • Limb infections, including cellulitis that have not been treated
    • Presence of Lymphangiosarcoma (a rare cancer due to long-standing lymphedema of the upper/lower extremities)

    In consideration of being permitted by DWT Wellness to participate in their services for NormaTec® Compression Therapy, I hereby state that I understand it may aggravate a pre-existing medical condition, or could lead to injury.  I am voluntarily assuming all risks of accident or injury to me (or my child) arising out of or in any way connected with the use of the services, equipment or facilities at DWT Wellness. 

    I hereby release DWT Wellness, Wellness Within Chiropractic, and its staff members, officers, directors, and agents of all liability for any damage, injury, or harm which may be caused by, a result of, or in any way associated with partcipation in this service of DWT Wellness & Wellness Within Chiropractic as a guest or member.

    I acknowledge that I am at least 18 years of age and have read, understand, and agree to this Release Statement, that it is an informed release and that I intend to be legally bound to it. 

    By submitting this form, I agree to the terms listed on the session and media release waiver.  Lastly, I am opting in to receiving promotional and/or follow up text messages.  Minors require a parent/guardian signature.

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  • TO BE READ AND SIGNED BY THE PARENT/GUARDIAN OF MINOR

    I hereby state that I am the parent or guardian of th eminor whose name and signature appears above.  I have carefully read this agreement and fully understand its contents.  I acknowlede that this release of liability is a legally binding contract between DWT Wellness and me.

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