Forms

1. Consent to Treatment

I, the undersigned, voluntarily consent to receive services provided by Essential Therapy CT, including but not limited to:

• Lymphatic drainage and post-operative massage

• Scar management and incision care

• Positioning assistance and mobility training

• Post-cesarean recovery services (e.g., scar massage, core rehabilitation)

• Personal training and therapeutic exercise

• Education on compression garments and post-surgical protocols

I understand these services are not a substitute for medical care and are provided by licensed and/or certified professionals within the scope of their practice. I acknowledge that I have been advised to consult with my physician regarding my post-operative condition and any contraindications for receiving bodywork or therapeutic interventions.

2. Acknowledgment of Risks

I understand that while Essential Therapy CT makes every effort to provide safe and effective care, certain risks may be associated with manual therapy, therapeutic movement, or scar tissue mobilization, including but not limited to:

• Bruising, tenderness, or temporary discomfort

• Swelling, fatigue, or emotional release

• Aggravation of pre-existing conditions

• Risk of infection or delayed wound healing if post-surgical guidelines are not followed

I agree to immediately notify my provider of any unusual discomfort or change in symptoms.

3. Client Responsibilities

I agree to:

• Disclose all relevant medical history, including recent surgeries, medications, and contraindications.

• Wear appropriate clothing and maintain personal hygiene for in-home services.

• Follow recommended home care protocols and seek medical attention as needed.

• Communicate honestly about my symptoms, comfort level, and progress.

4. Limitations of Service

I acknowledge that:

• Essential Therapy CT does not diagnose conditions, prescribe medications, or provide emergency medical care.

• Services rendered are not covered by insurance and are elective in nature.

• Results may vary based on individual health status, post-operative progress, and compliance.

5. Home Visit Consent and Liability

I understand that services will be rendered in my home or designated recovery space. I agree to provide a safe, clean, and private environment for care. I release Essential Therapy CT and its staff from liability for injuries, accidents, or damage that may occur on or around the premises during the provision of services.

6. COVID-19 and Communicable Illness Policy

I affirm that I will inform my provider of any symptoms of illness (fever, cough, contagious skin conditions, etc.) prior to appointments. I understand that services may be rescheduled at the provider’s discretion for the safety of both parties.

7. Cancellation and Payment Policy

• A minimum of 24 hours’ notice is required for cancellations or rescheduling. Late cancellations or no-shows may result in a full session fee.

• Payment is due at the time of service unless otherwise arranged.

• Essential Therapy CT reserves the right to discontinue care at any time.

9. Liability Waiver and Release

I hereby waive, release, and hold harmless Essential Therapy CT, its owners, employees, agents, and contractors from any and all claims, liabilities, damages, or demands arising from my participation in services, except in cases of gross negligence or willful misconduct. I understand this release applies to myself and my personal representatives, heirs, and assigns.

10. Acknowledgment and Signature

By signing below, I acknowledge that I have read, understood, and agree to the terms of this consent and waiver. I have had the opportunity to ask questions and receive answers. I understand that I may withdraw my consent at any time, though services will be discontinued if consent is revoked.