Questions of a personal nature:
You need to let us know:
Clinical Physical Contact:
Risks related to training:
Children and Minors:
Consent from a custodial parent is required prior to the commencement of services. This applies to anyone under the age of 18.
By signing this form, you are agreeing that your practitioner may discuss your case with another practitioner, trainer or allied health professional for case conferencing or referral purposes.
Photos, Videos, use of likeness, feedback for business promotion use:
We may take photos, videos, written or verbal feedback of our sessions for use on social media and other marketing media. By signing this form, you are giving your consent to our use of these materials.
Please see our website or ask for a handout for our complaint’s procedure.
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