Please take a moment to carefully read the following information, sign and submit.
I understand that the exercise and posture/alignment therapy I receive is provided for the purpose of posture and alignment correction, muscular imbalance correction, corrective exercise instruction and guidance, restoration of normal musculoskeletal function, reduction of pain caused by diseases, injuries or postural dysfunctions. I further understand that exercise and posture therapists, manual therapists, personal trainers and wellness coaches are not qualified to diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session(s) given should be considered as such. I should see a physician, or other qualified medical specialist for any mental or physical ailment that I am aware of. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the exercise therapist and personal trainer updated as to any changes in my medical profile and understand that there shall not be liability on the therapist’s part should I forget to do so. I understand that I have enrolled in the personalized health and exercise program offered through Certified Personal Trainer, Certified Exercise and Posture/Alignment Therapist and Certified Massage and Manual Therapist, Nesve Yayalar and her company, Great Anatomy, Inc. I recognize that the program may involve physical activity including, but not limited to, muscle strength and stretching exercises, and other various exercise activities. I also agree that the program may consist of therapeutic exercises, mobilization, massage and manual therapy, muscle testing, exercises and physical agents to aid in achieving my maximum potential for recovery within my capabilities. I agree to cooperate fully, to participate in all physical exercises, and to comply with the plan of care as it is established. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by Nesve Yayalar. In consideration of my participation in this program, I hereby release Nesve Yayalar and her company, Great Anatomy, Inc. from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided exercise and posture therapy sessions. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Nesve Yayalar and her company Great Anatomy, Inc. from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, allergic reactions or any other illness or soreness that I may incur, including death.
I am purchasing the services of Great Anatomy, Inc. to design an exercise program to correct my posture and alignment, muscular imbalances, and aid in my discomfort and pain, improve my muscle strength, flexibility and mobility, alleviate my pain and discomfort and to enhance my wellness and health goals. I will not hold Nesve Yayalar and her company, Great Anatomy, Inc. personally liable for any problems, illnesses or injuries that might occur due to a sudden change in my eating or exercise habits. This program does not replace the advice of a medical doctor, or other medical provider or treatment. I have revealed any and all necessary information about myself to prevent any possible complications to Nesve Yayalar and her company Great Anatomy, INC.
Cancellation Policy: I understand that unpredictable situations can arise, but I do require 24 hour notice to cancel appointments. If notice is not given, you will be charged for the session. The amount of the fee will be equal to 100 % of the appointment fee. Individual circumstances will play a role in the therapist’s decision to charge cancellation fee. If you are more than 15 min late for your appointment, I may not be able to accommodate you. In this case, the same cancellation fee will apply. I will do my very best to reschedule your appointment for another time that is convenient to you.
You have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.
