Phoenix Performance & Rehab Consent
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
PHOENIX PERFORMANCE & REHAB — EVENT PARTICIPATION WAIVER: Acknowledgment of Services- I understand that Phoenix Performance & Rehab is offering wellness services at this event, which may include chiropractic assessment, soft tissue work, movement screening, dry needling, or similar hands-on services. I understand these services are being provided in a community/event setting and are not a substitute for a full evaluation, diagnosis, or ongoing medical care. Assumption of Risk-I understand that participation in physical assessment and hands-on treatment carries inherent risks, including but not limited to muscle soreness, discomfort, bruising, or aggravation of an existing condition. I voluntarily choose to participate with full knowledge of these risks. Disclosure of Health Conditions- I confirm that I have disclosed any relevant health conditions, injuries, pregnancy, or medical concerns to the practitioner before receiving services, and I understand it is my responsibility to do so. Release of Liability- In consideration of being permitted to participate, I release and hold harmless Phoenix Performance & Rehab, its owners, employees, and representatives from any claims, liabilities, or damages arising from my voluntary participation, except in cases of gross negligence or willful misconduct.
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Consent to Treatment: I voluntarily consent to receive the services provided at this event. I have read, understand, and agree to the above
Signature- Consent to Treatment: I voluntarily consent to receive the services provided at this event.
I'd like to hear from Phoenix Performance & Rehab about services, offers, and events. I understand I can opt out anytime.
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