Client Waiver & Consent Form

Please read and sign before your first visit.

Client Information
Informed Consent

Nature of Services. Rooted Manual Therapy provides functional manual therapy and advanced bodywork. These services are intended to support movement, function, and general wellbeing. They are not a substitute for diagnosis or treatment by a licensed physician, and are not intended to diagnose, treat, cure, or prevent any disease or medical condition.

Health Disclosure. I confirm that I have disclosed relevant health history and current conditions to the best of my knowledge, and I agree to inform my practitioner of any changes before future sessions.

Assumption of Risk. I understand that manual therapy, like any hands-on bodywork, carries some risk of soreness, discomfort, or aggravation of an existing condition. I voluntarily choose to receive services with this understanding.

Right to Stop. I understand that I may ask my practitioner to adjust or stop any technique at any time, for any reason, during a session.

Confidentiality. Information I share will be kept private and used only to inform my care, except where disclosure is required by law.

Release. Having read the above, I voluntarily consent to receive manual therapy services from Rooted Manual Therapy and release the practice from liability for outcomes arising from disclosed or undisclosed health conditions.

Your information is sent directly to Rooted Manual Therapy and is not shared elsewhere.

Thank You

Your waiver has been received. We'll see you soon.