Please take a moment to carefully read the following information, sign and submit.

Waiver and release of liability

I understand that the exercise and posture therapy I receive is provided for the purpose of posture and alignment 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 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 Therapist and Certified Massage 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, stretching and cardiovascular exercises, and other various exercise activities. I also agree that the program may consist of therapeutic exercises, mobilization, massage, 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, 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, aid in my discomfort and pain, improve my muscle strength, flexibility and cardiovascular fitness, and to enhance my wellness and fitness 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 can be charged for the session at the therapist’s discretion. Individual circumstances will play a role in the therapist’s decision to charge cancellation fee.

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.

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Massage Therapy Informed Consent

Agreement

I understand that the massage given to me by CAMTC and NCBTMB certified massage therapist, certified medical massage therapist Nesve Yayalar, owner of Great Anatomy, Inc, Massage Therapy is for the purpose of (manual therapy, stress reduction, pain reduction, injury rehabilitation, relief from muscle tension and any present soft tissue restriction, breakdown adhesion or scar tissue, increasing circulation, or specific reasons stated here).

I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy.

I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have.

I have stated all my known physical conditions and medications, and I will keep my massage therapist updated on any changes.

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Massage Therapy Rules and Regulations


                                      

Please READ and SIGN the rules and regulations for massage therapy prior to your first appointment.

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