Injury Screen - Restore Hyper Wellness

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

1100 S Lamar Blvd Suite 2114

Email *

Name *

Phone Number

Mind Body Physiotherapy has my permission to use my photograph and/or video publicly to promote these businesses. I understand the images and/or video may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty fee or other compensation shall become payable to me by reason of such use.

I have read and consent to the Photo/Video Release Policy

I do NOT want my Photo or Video to be used

I understand that this injury screen is for educational purposes and not intended to treat or diagnose any musculoskeletal conditions. Participation in this does not guarantee injury prevention. I desire to engage voluntarily in today’s activities. By selecting “I Understand” completely and unconditionally releases all liability to Mind Body Physiotherapy. *

I understand I am voluntarily consenting to participation in workshop

I do not want to participate in this workshop

Required

Click here to sign up for time *

Check to confirm

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Mind Body Physio Therapy. Report Abuse

Forms