Waiver and Informed Consent
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1. Description of Services:
I understand that I am voluntarily receiving a one-time gait analysis with chiropractic adjustments and/or myofascial release treatment from Anaiah Christensen, DC. These services are intended to assess movement patterns and provide soft tissue release but are not a substitute for medical treatment or diagnosis by a licensed physician.
2. Acknowledgment of One-Time Treatment & No Documentation:
I acknowledge that:
This is a one-time treatment provided at an event setting.
No official documentation or medical records will be created or maintained for this service.
No ongoing treatment, rehabilitation, or follow-up care is implied or provided beyond this session.
3. Risks & Limitations:
I understand that:
chiropractic adjustments, myofascial release and movement assessments involve physical contact, manual therapy techniques, and temporary soreness, mild discomfort, or bruising may occur.
I am responsible for informing the provider of any injuries, medical conditions, allergies, or sensitivities that may impact my treatment.
4. Liability Release:
I release Anaiah Christensen, DC, and any event organizers, sponsors, or affiliated parties from any liability for injuries, adverse reactions, or complications that may arise from this session. I understand and agree that:
I assume full responsibility for my health and well-being during and after treatment.
Any injuries or issues that arise following this session are not the responsibility of Anaiah Christensen, DC.
I will not hold Anaiah Christensen, DC, liable for any claims related to this treatment.
5. Media & Social Media Release:
I give permission for photos and/or videos taken during this session to be used by Anaiah Christensen, DC, for educational, marketing, or promotional purposes including but not limited to social media, website, and printed materials. I understand that no personal health details will be shared.
6. Consent to Treatment:
I voluntarily consent to receive a one-time gait analysis with chiropractic adjustments and/or myofascial release therapy and understand that I can withdraw this consent at any time during the session.
Electronic Signature (type name)