Island Performance Health, LLC — Please read carefully before signing.
Thank you for choosing Island Performance Health, LLC for your physical therapy needs. Please read this form carefully and sign below to acknowledge your understanding and agreement.
I, the undersigned, do hereby agree and give my consent for Island Performance Health, LLC to provide medical care and treatment considered necessary and proper in diagnosing and/or treating my condition. No treatment for any condition or disease is without risk of side effects and physical therapy is no exception. Fortunately, unwanted side effects are typically rare, minor and/or transient for the techniques that will be utilized by the therapist(s). I have the right to ask questions and decline any treatment at any time.
By signing below you indicate you are aware of, and accept the risks of physical therapy treatment, and give your full consent for the therapist to provide such treatment. We take great care with our patients and the resolution of your symptoms is our primary concern. Please feel free to express concerns or questions to your therapist.