Presentation & Video/Photo Release Form

While the information you are receiving is intended to offer benefits to you, there may be unknown factors to Santa Cruz Mobile Physical Therapy & Wellness, Inc., such as your past medical history, that would require modifications or alternate suggestions of today's material. I agree to use my judgment based on my known medical history and current fitness level when implementing these ideas. Should I have specific questions regarding information from this presentation and my own condition, I will consult personally with Santa Cruz Mobile Physical Therapy & Wellness, Inc.  and/or my physician. I hereby do NOT hold Santa Cruz Mobile Physical Therapy & Wellness, Inc.  responsible for any unforeseen injuries that may occur.

I  am aware that photographs and/or videos may be taken during this presentation by me or my staff  for the purpose of future marketing material. I agree to allow my images and/or videos  to be used for the sole purpose of marketing. I understand that my private information, such as name, will not be used with any recorded images or videos.