Consent + Acknowledgment

I understand that the services provided today by REJUVENATION Chiropractic + Sports Rehab may include soft tissue therapy, cupping, kinesiology taping, stretching, and/or recovery compression. These services are intended to promote relaxation, recovery, and wellness - not to diagnose or treat medical conditions.

I acknowledge that:

• I am voluntarily participating in these services.

• I have disclosed any relevant health conditions or injuries.

• Mild soreness or redness may occur after treatment.

• I release the provider from any liability related to these services.

Name

First Name

Last Name

Email

Phone Number

(###)

###

####

Emergency Contact

First Name

Last Name

Any health concerns or injuries we should know about?

Consent

I have read and understand this consent and voluntarily agree to receive cupping or recovery compression services.

Date

MM

DD

YYYY