I understand first and foremost that I am providing consent to receive Wellness Services and/or Physical Health Coaching. The program being provided to me is for the purpose of improving or maintaining my overall health, and is NOT to be regarded as skilled physical therapy.

 

While the wellness/coaching program that is being provided during the agreed upon time frame is intended to offer benefits to (you), there may be unknown factors to Preempt Physical Therapy, LLC, such as past medical history, that would require modifications or alternate suggestions of the wellness/coaching program. It is highly recommended that you provide pertinent information regarding your overall health status which may impact or be affected by engaging in physical activity. This includes: previous surgeries, any known heart conditions, current physical ailments, or any other pre-existing conditions.

 

I agree to use my judgment based on (my) known medical history and current fitness level when implementing these ideas.  Should I have specific questions regarding information from this program and my own condition, I will consult personally with my physician. 

 

I hereby do NOT hold Preempt Physical Therapy, LLC responsible for any unforeseen injuries or adverse responses to wellness/coaching services that may occur. 

 

Additionally, I consent to a physical screen, if requested, to be performed by Preempt Physical Therapy, LLC.