Physical Therapy Consultation

Waiver & Consent Form

Event: The Boston Run Show & The Boston Outdoor Expo

Consent to Participate in Consultation
I, the undersigned, hereby give my consent to participate in a physical therapy consultation with Mvmtology, LLC. I understand that the consultation may include discussion of my symptoms, movement and medical history, and physical assessment and evaluation. 

Understanding of Risks and Acknowledgment of Health Conditions
I understand that physical therapy consultations are non-invasive and may involve basic evaluations of my physical condition. However, I acknowledge that any physical activity, including assessments, carries inherent risks, and I may experience discomfort or injury, either during or after the consultation.

I confirm that I am in good health and free of any medical conditions or injuries that would prevent me from safely participating in this consultation. If I have any existing medical conditions, injuries, or concerns, I agree to inform the physical therapist before beginning the consultation.

Waiver of Liability and Release of Claims
In consideration of receiving a physical therapy consultation from Mvmtology, LLC, I, for myself, my heirs, executors, administrators, and assigns, hereby waive, release, and discharge Mvmtology, LLC, its officers, employees, agents, and any associated personnel from any and all claims, liabilities, injuries, damages, or losses that may arise out of or in connection with my participation in the consultation, whether caused by negligence or otherwise.

Medical Emergency Authorization
In the event of a medical emergency, I authorize Mvmtology, LLC to seek medical treatment if necessary and agree to bear all costs associated with such treatment.

Health and Safety – COVID-19 and Germ Transmission
I acknowledge that the consultation will take place in a public space where there may be potential exposure to COVID-19 or other communicable diseases. I understand that while Mvmtology, LLC will take reasonable precautions to ensure a safe environment, there is still a risk of exposure to germs, including through surfaces or close interaction during the consultation.

By participating, I confirm that I do not currently have any symptoms of COVID-19 or any other contagious illness. I agree to follow all health and safety protocols as requested by Mvmtology, LLC, including wearing a mask, using hand sanitizers, and maintaining social distancing when possible.

I understand that I should not participate in the consultation if I am feeling unwell, exhibiting symptoms of illness, or have been in contact with someone who has tested positive for COVID-19 in the past 14 days.

Privacy and Confidentiality
I understand that the physical therapy consultation will take place in a public space at The Boston Run Show & The Boston Outdoor Expo, and while Mvmtology, LLC will make reasonable efforts to maintain confidentiality, the consultation may not be fully private. I acknowledge that there is a possibility that others may overhear or observe parts of the consultation. I consent to the consultation taking place in this setting and understand the limitations regarding privacy.

Thank you for visiting mvmt·ology at The Boston Run Show & The Boston Outdoor Expo!

For any further inquiries, please contact us here.