Health Survey

Please correct the errors described below.

I understand that the therapist/instructor does not diagnose illness, disease, or any other physical or mental disorder. As such, the therapist/instructor does not prescribe medical treatment or pharmaceuticals, nor does s/he perform any spinal manipulations. I also understand that this activity is not a substitute for medical examinations and/or diagnosis and that it is recommended that I see a physician for any physical ailment that I might have.

My participation in this activity is voluntary and at my own risk. To the best of my knowledge, the health information above is true and accurate. I hereby release respective owners, instructors, and therapists for any liability for any claims, demands, injuries, services, equipment or facilities provided by the therapist. I have carefully read with a full, definite, and clear understanding of the forgoing provisions and freely enter into within agreement of waiver/release.

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