Waiver
I, {name}, have completed this form to the best of my knowledge.
Consent for Treatment
I voluntarily consent to receive post-operative manual lymph drainage and bodywork services provided by Elizabeth Rivera and MyoQi Athletics LLC. I understand that post-operative manual lymph drainage is designed to be a health and recovery aid and not a substitute for medical care by a nurse or physician. I acknowledge that results may vary based on patient's consistency with long-term recovery and their individual health conditions and needs.
Understanding of Services
I understand that post-operative manual lymph drainage (MLD) and bodywork services are designed to be a health and recovery aid, and are not a substitute for medical care provided by a licensed nurse or physician.
I understand that post-operative MLD is intended to:
- Reduce fluid retention and bruising
- Decrease pain and swelling
- Reduce scar and fibrosis formation
- Improve skin texture and elasticity
- Support immune function to reduce infection risk
I acknowledge that results may vary based on my individual health, the nature of my surgery, and my adherence to recommended aftercare protocols.
Lymphatic System Stimulation: Post-operative treatments may involve stimulation of the lymphatic system to help the body release retained fluids, toxins, and/or residual anesthesia after surgery. This may include, when clinically indicated, the inguinal lymph nodes located in the groin area, as swelling or discomfort in this area can occur.
By signing below, I give my consent to receive treatment in the inguinal region if needed. If I do not consent, I understand this area will not be treated, and any swelling, inflammation, fibrosis, or discomfort in that region will be my responsibility to address.
If I experience pain or discomfort during any part of the session, I will immediately inform my therapist so the pressure or technique can be adjusted to my comfort level. I understand my therapist is not qualified to diagnose, prescribe, or treat any illness, and that all medical concerns should be directed to my healthcare provider.
I affirm that I have disclosed all relevant medical history and will inform my therapist of any changes to my health prior to future sessions. I release Elizabeth Rivera and MyoQi Athletics LLC from liability for any adverse effects that may result from withholding such information.
Consent for Photography/Social Media Release
I consent to the taking of photographs or videos during my sessions for the purpose of documentation, treatment planning, and promotion. I understand that these images may be used for social media, marketing, and educational purposes. Tattoos can be blurred upon request for privacy. I acknowledge that I will not receive any compensation for the use of these images. If I do not consent to photography or social media usage, I will inform my therapist prior to the start of my session. I can revoke my consent at any time by emailing info@myoqi.com.
Privacy Policy
I hereby consent to MyoQi Athletics LLC possessing and utilizing my medical and personal information for the purpose of providing post-operative manual lymph drainage treatments. All information provided will be kept confidential and will not be disclosed to third parties without my written consent, except as required by law.
By signing this release, I waive and release Elizabeth Rivera and MyoQi Athletics LLC, along with their representatives, from any and all claims and liability, past, present, and future, relating to manual lymph drainage and bodywork.