Client Intake & Waiver Form

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

IG name (optional)

Follow me at @NASPerformance

Preferred contact method

What brings you here today? (checkboxes, multiple allowed)

What area needs the most attention?” (checkboxes, multiple allowed)

Are you currently experiencing any injuries or medical conditions we should be aware of?

Are any of these currently true for you?

How did you hear about NAS Performance & Recovery?

Waiver & Release of Liability

I understand that the recovery services provided by NAS's Performance & Recovery, including assisted stretching, mobility work, soft tissue techniques, cupping, scraping/Grafton, and related recovery modalities, are intended for general wellness, recovery, and performance enhancement purposes only and are not a substitute for medical care, diagnosis, or treatment.

I acknowledge that participation may involve risks including soreness, discomfort, bruising, aggravation of existing conditions, or injury.

I confirm that I have disclosed any relevant injuries, medical conditions, or physical limitations.

I understand that I may stop the session at any time and communicate discomfort immediately.

By agreeing below, I voluntarily assume all risks and release NAS's Performance & Recovery and Nico Santiago from liability for claims, injuries, or damages arising from participation, except in cases of gross negligence or intentional misconduct.

I consent to receive recovery services from NAS's Performance & Recovery.

Signature