I am 18 or older, or the legal guardian for the minor listed below *

Name *

First Name

Last Name

Phone

(###)

###

####

Marketing Release *

I understand that if any photographs and/or video of me are taken, they may be used for promotional/marketing purposes, and I hereby authorize Radius Physical + Sports Rehab to publish images taken of me for the use in print, online, and video-based marketing materials and other publications.

Waiver *

I voluntarily consent to receive services from Radius Physical + Sports Rehab, which may include injury assessments, manual therapy, stretching, exercise, and other related physical rehabilitation or performance-enhancing activities. I understand that participation in these services involves inherent risks, including but not limited to pain, soreness, aggravation of existing conditions, or injury. I hereby release, discharge, and hold harmless Radius Physical + Sports Rehab, its officers, employees, agents, and contractors from any and all claims, demands, or causes of action arising out of or in connection with my participation in these services, including any injuries or damages resulting therefrom.