TO THE PATIENT: You have the right, as a patient, to be informed about your condition and the recommended diagnostic procedure to be used so that you may make the decision whether or not to undergo any suggested treatment after knowing the risks and hazards involved. This consent form is simply an effort to obtain your permission to perform the evaluation necessary to identify the appropriate treatment for any identified condition(s). Dynamic Physiotherapy utilizes hands-on physical therapy approach. Though highly specialized, treatment consists primarily of manual therapy techniques and treatment forms that are in line with evidence-based practice. Forms of deep tissue massage, therapeutic exercise programs, gait training, neuromuscular re-education, cupping, myofascial release, bone and soft tissue manipulation, as well as other treatment modalities may be used. Some of the hands-on treatment techniques require deep pressure which may cause bruising and periods of increased soreness which may last from 1-72 hours and may change and move to other parts of the body. This is not unusual and is rarely a concern, however, please ask if you have any concerns or questions. The number of treatments needed and recovery time can vary widely due to the age of injury, number of times injured, age of patient and many other contributing factors. I have read and fully understand the above statements. I understand the nature of the treatments at Dynamic Physiotherapy, LLC and I authorize the fully trained staff to use treatment techniques as deemed necessary for my safe and effective recovery. I CERTIFY THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE WRITTEN STATEMENTS. PLEASE LIST ANY MEDICAL CONDITIONS THAT MAY IMPACT TREATMENT BELOW: