Pneumatic Compression (Normatec Compression) is not recommended for people with any of the following diagnoses: 

Acute pulmonary edema

Acute thrombophlebitis;

Congestive heart failure

Deep Vein Thrombosis (DVT)

Inflammatory phlebitis or episodes of Pulmonary Embolism

Acute infections

Infections in the limb, including cellulitis, without appropriate antibiotic coverage

Presence of cancer unless for palliative care

Wounds, lesions, or tumors at or near the site of application

Where an increased venous and lymphatic return is undesirable

Bone fractures or dislocations at or near the site of application

Cold Urticaria

Cold Erythema

Cold Hemoglobinuria

Other indications as identified by the treating physical therapist 

I deny having any of the above listed.

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Cryotherapy is not recommended for people with any of the following diagnoses: 

Raynaud’s syndrome

Diagnosis of circulatory compromise

Peripheral Vascular Disease

Cold intolerance

Cryoglobulinemia

Cold urticaria

Paroxysmal Cold Hemoglobinuria 

I deny having any of the above listed diagnoses.

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Transcutaneous Electrical Nerve Stimulation (TENS) is not recommended for people with any of the following diagnoses: 

Demand-type pacemaker

Osteomyelitis

Hemorrhage

Impaired sensation, mental status, communication

Cardiovascular disease

Malignancy

Dermatological conditions

Stroke or Seizures

Pregnant, History of spontaneous abortion in pregnant women 

I deny having any of the above listed diagnoses.

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Photography/Video Release 

Participants involved in any activities offered by ACE Physio & Performance, PLLC may be photographed or videotaped during any and all services. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the ACE Physio & Performance, PLLC website/social media or in any editorial, promotional or advertising material produced and/or published by ACE Physio & Performance, PLLC. 

I agree to the above listed statements.

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Parent/Guardian Release for Minor 

I, the parent/guardian of my son or daughter that I'm signing up 18 years old and under hereby authorize and consent to recovery/wellness therapies provided by ACE Physio & Performance, PLLC for my child with and without my presence. This authorization shall be valid from the beginning of membership to termination of membership date. I do hereby indemnify and hold harmless ACE Physio & Performance, PLLC, its caregivers, staff, or any person involved in providing care to my child who act in reliance upon this authorization. A child's parent or legal guardian must be contacted to discuss any recovery/wellness treatment changes. Please understand that this form is not intended to replace any other forms that the practice may require prior to treating your child. (Example: Medical director, HIPAA, treatment consents). All other documentation will need to be updated/signed prior to any treatment being initiated. In the event of a life-threatening emergency, the child may be treated without parental consent. We will do our best to contact the parents or legal guardian. Parent/Legal Guardian agrees by marking the Parental Consent Form Phone number where parent/guardian can be reached at the time of the appointment. 

I agree to the above listed statements. 

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Indemnification 

The participant recognizes that there is risk involved in the types of activities offered by ACE Physio & Performance, PLLC. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless ACE Physio & Performance, PLLC, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by ACE Physio & Performance, PLLC, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by ACE Physio & Performance, PLLC.

Terms & Conditions 

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights. Also by signing this waiver, I have read and understood all payment terms and conditions with my membership. 

I agree to the statements listed in this recovery release form.

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Waiver and Release of Liability Express assumption of risk: 

I, the undersigned, am aware that there are significant risks involved in all aspects of wellness and preventative therapy. These risks include but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under the direction of ACE Physio & Performance, PLLC. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

Wellness 

I understand that the Wellness treatments I receive are considered Wellness and NOT Physical Therapy. If my symptoms change, then I will inform ACE Physio & Performance, PLLC to transition to Physical Therapy. I understand that these services cannot be billed to my insurance company. 

I agree to the above statements.

Signature 

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by completing this document is equivalent to my signature and it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by submitting this form I am waiving valuable legal rights. If signing for a Minor, Parent or Guardian (this includes Team Coaches) assumes all responsibility for Membership Waiver, Dues, and Liability.