Surgeries / Goals
List:
Previous and upcoming surgeries
Goals:
What do you hope to achieve or alleviate by working with Immersion PNW?
Informed Consent for Personal Training and Assisted Stretching
*
I choose to participate in athletic training, personal training, wellness, and/or manual sessions with Shantyel Bowman, MAT, ATC, CPT at Immersion PNW. I understand the risks involved and take full responsibility for informing her of any medical conditions, injuries, or limitations that may affect my safety.
Assumption of Risk:
I acknowledge the risks associated with training, corrective exercise, and manual therapy / assisted stretching, and release Shantyel Bowman, her staff, and Immersion PNW from any liability related to my participation.
Health & Medical Clearance:
I confirm I have medical clearance to participate and will inform Immersion PNW of any changes in my health. If necessary, I will provide a doctors note for participation.
Goals & Communication:
I understand the importance of setting realistic goals and agree to communicate any concerns or discomfort during or post sessions.
Privacy:
My personal information will remain confidential and protected under HIPAA, unless disclosure is required by law.
Assisted Stretching & Manual Therapy:
I understand assisted stretching and manual therapy may involve physical contact. This may include hands-on techniques or tools like cupping or IASTM (e.g., Gua Sha), which may cause skin discoloration. I will communicate any abnormal discomfort or reactions.
Commitment to Safety:
I agree to follow all instructions to ensure my safety and maximize the benefits of each session.
By typing my name below, I acknowledge and accept these terms and assume all associated risks.