In agreeing to receive care provided by Beyond Recovery Physical Therapy (hereinafter “Beyond Recovery”), and to use the facilities provided therefore by Beyond Recovery located at 2026 W Vista, Springfield, MO., I agree as follows:

II. I fully understand that Beyond Recovery operates for the sole purpose of physical therapy evaluations and/or treatments, activities, wellness, prevention exercises, and fitness services. Fitness services are provided for the purpose of injury prevention, wellness, performance, and recovery. I hereby consent to voluntarily engaging in the aforementioned activities and understand that my participation is completely voluntary and that I have the freedom to cease services at any time, without repercussions.

III. I fully understand and acknowledge that while Beyond Recovery operates for the purposes listed above, my involvement with Beyond Recovery is not a substitute for medical care from a licensed physician. I fully acknowledge and understand that if a health issue arises that I should contact my physician, or if I am having a medical emergency I should call 911 immediately.

IV. I understand and acknowledge that injury prevention, recovery, and wellness services do not guarantee an entire elimination of injury. These services will not be a substitute for medical care, and it is recommended that I continue to work with my primary care physician and/or any other physician to follow up with my medical conditions.

V. I understand that in the State of Missouri, I will need to obtain a physician referral for consecutive treatment sessions after an in-person assessment with my Physical Therapist to continue Physical Therapy. Outside of the State of Missouri, we will be NOT be engaging in Physical Therapy, but I understand that I am hiring Beyond Recovery for strength training instead.

VI. I fully understand and acknowledge that during my initial evaluation, I will undergo a system screening of the musculoskeletal and nervous systems. I acknowledge and understand fully that this screening is not for the purpose of diagnostic or to take the place of advice from a licensed physician.

VII. I fully acknowledge and understand that there are inherent risks involved with exercise programs despite the best efforts of any Beyond Recovery employee or representative. These include but are not limited to: abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, heat related illnesses, and in very rare instances, heart attack, stroke, or even death.

VIII. I further understand and acknowledge that there are additional risks with therapy, exercise, and equipment that could result in bodily injury, including, but not limited to injuries to the muscles, ligaments, tendons, bones, and/or joints of the body. Sessions may result in soreness after activity, which is to be expected, but every effort will be made to minimize these risks. It is my responsibility to uphold and protect my own personal safety while performing exercises. I will inform my physical therapist/trainer if something does not feel right prior to, during, or after exercise, to best reduce the chance of injury. I further fully understand that the exercises prescribed are recommendations and if they make my symptoms flare up for more than 24 hours, I should contact Beyond Recovery and cease exercises until my physical therapist has provided further instructions.

IX. I fully understand that some medications may alter my response to exercises or therapeutic interventions. I hereby attest that I have provided a list of medications that I am currently taking. This includes, but is not limited to vitamins, supplements, over the counter medications, and/ or prescription medications. I understand that my Physical Therapist will not disclose this information to any other person.

X. All claims and disputes arising or relating to this Agreement are to be settled by binding arbitration in the State of Missouri or another location mutually agreeable to the parties. An award of arbitration may be confirmed in a court of competent jurisdiction.

XI. This Agreement shall be governed and construed in accordance with the laws of the State of Missouri and will be adjudicated in a court of competent jurisdiction in the county of Greene.

XII. This Agreement sets forth the entire understanding between the parties hereto and supersedes all other prior agreements between the parties with respect to the subject matter hereof. This Agreement may only be amended by a written document duly executed by all parties.

XIII. I fully acknowledge and agree that I have been afforded the opportunity to read each line carefully without any influence, and that I fully understand, comprehend, and consent to the entire agreement. I acknowledge and agree that I have been afforded the opportunity ask any questions.

XIV. I have read the above waiver and consent form and by signing it agree to the aforementioned. I hereby release Beyond Recovery, and any representative, agent, or employee thereof from any responsibility or liability due to my participation in physical therapy from any claims or actions that I currently have or may have in the future. I further release Beyond Recovery from liability for personal injury, property damage, or wrongful death caused by negligence and and/or any other cause. I am fully aware that I am participating in these sessions at my own risk and will not hold those named above responsible in the event of my incurring a new injury or exacerbating any previously existing conditions. If I have any medical conditions, I represent that I have consulted with my physician to make sure that physical therapy is appropriate for me to participate in.