I understand that the sessions I will be receiving is:
for therapeutic purposes and is non-sexual
to assist in balancing and aligning the physical body through direct manipulation, appropriate contact and movement education.
I understand that the practitioner makes no warranties or guarantees as to the results of the process and give consent for the practitioner to apply appropriate physical contact to my body. I understand that if I experience any unusual discomfort and/or pain during my session, it is my responsibility to actively communicate this to the practitioner so that he/she can adjust the pressure or technique being used, or if necessary, end the session. I may also, at any time, request to terminate the session.
I understand that the practitioner does not diagnose illness, disease, or any further physical or mental disorders and the session should not be a substitute for medical treatment or diagnoses from a medical professional when such attention is required.
I acknowledge that the information I have provided on this form is correct and current to the best of my knowledge, and that I have provided a truthful and accurate medical history. I understand that it is my responsibility to inform the practitioner of any changes to this information.