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CLIENT CONSENT
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CLIENT CONSENT STATEMENT/WAIVER OF LIABILITY
Please read carefully, and sign and date below. I understand that the sessions provided at Tenth House Health involve a variety of manual  techniques that manipulate the muscles, soft tissues and/or cranial sacral system and movement sequences designed for therapeutic support. I further understand and acknowledge that in no way are these services meant to be construed by me as the diagnosis or treatment of disease, but rather as an aid in the healing process. I understand that the practitioner will give me a clear explanation of what they found in their assessment and discuss a treatment plan that is suitable for me and that I may refuse any and all techniques at any time. I understand the practitioner may recommend remedial exercises and home care. I assume full responsibility for my choice to use or apply any portion of the information or instruction I receive from my practitioner.I understand that Craniosacral therapy, manual therapy, and movement sequences are not substitutes for medical intervention. I understand that my practitioner will discuss potential side effects from treatment with me and furthermore will not hold the practitioner responsible for any and all normal side effects. Because our practitioners adapt their work to specific medical conditions, I affirm that I have stated all my known history, current symptoms and diagnoses and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner part should I fail to do so. By signing and/or submitting this form I affirm the accuracy of the information I have provided and understand and agree to the policies above. I declare that I have given the most accurate information to my knowledge, and I understand that the information given will be used to create a personal treatment plan and create a client file. I therefore give my consent to the therapist to perform this assessment, and treatment and to collect and use my personal information.
CANCELLATION POLICY
Tenth House Health has a 24-hour cancellation policy. If you need to change or cancel your appointment, you must notify us at least 24 hours in advance. Missed appointments and those cancelled without the required 24 hours notice will be subject to the full cost of the appointment. Current exception:  if you suddenly experience any symptoms that may be indicative of COVID-19 or have been exposed to someone infected with COVID-19 less than 24 hours before your scheduled appointment, you will be offered a make-up appointment (valid for 3 months) for the charge for the cancellation.
ADDITIONAL POLICIES
I attest that I have read and understood the above information and I agree comply with to Tenth House Health terms and conditions. If so, kindly sign (or type) your name below.
I understand and am aware of treatment fees and cancellation policy and that payment is due at the time of session. I understand that late arrival for my appointment will result in a shorter session time. I am aware that Tenth House Health is not responsible for any lost, stolen or damaged articles.I am aware that all information provided is private and confidential and will not be released without my written consent.
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