PEMF Therapy Waiver
Liability Release, Assumption of Risk & Informed Consent
This agreement ("Agreement") is entered into between [Business Name], located at [Street Address], [City], [ST] ("Provider"), and the undersigned client ("Client") in connection with pemf therapy waiver services. By signing below, the Client acknowledges that they have read and understood each provision herein.
1. Acknowledged Risks Specific to This Procedure
The Client understands that the following risks are inherent to this specific service and cannot be eliminated even with proper technique and care:
- A complementary service with no medical claims
- Contraindicated with pacemakers or implants
- Mild tingling during sessions
- Not for use during pregnancy
- Disclose any implanted devices
2. Informed Consent to PEMF Therapy
The Client consents to pemf therapy provided by the Provider, confirms they have disclosed relevant health information, and has had the opportunity to ask questions. The Client understands that individual results vary, that this service is not a substitute for medical care, and that outcomes are not guaranteed.
3. PEMF Therapy Risks and Safety
The undersigned specifically acknowledges and assumes the following risks associated with pemf therapy: A complementary service with no medical claims; Contraindicated with pacemakers or implants; Mild tingling during sessions; Not for use during pregnancy; Disclose any implanted devices. The undersigned has disclosed any condition that may increase these risks and accepts them voluntarily.
4. Assumption of Risk
The Client voluntarily elects to receive the services described in this Agreement with full knowledge of the inherent risks involved. The Client understands that no procedure is entirely without risk and that individual results, reactions, and tolerances vary. The Client knowingly and freely assumes all such risks, both known and unknown, even if arising from the negligence of the Provider, and assumes full responsibility for participation.
5. Release and Waiver of Liability
In consideration of being permitted to receive the services, the Client hereby releases, waives, discharges, and covenants not to sue the Provider, its owners, employees, and agents from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury that may be sustained while receiving the services, to the fullest extent permitted by law.
6. Medical History and Disclosure
The Client affirms that they have disclosed to the Provider all relevant medical conditions, allergies, medications, and prior adverse reactions. The Client understands that withholding such information may result in injury for which the Provider bears no responsibility, and agrees to promptly notify the Provider of any change to their health status prior to receiving services.
7. Indemnification and Hold Harmless
The Client agrees to indemnify, defend, and hold harmless the Provider from any loss, liability, damage, or cost, including reasonable attorneys' fees, that the Provider may incur as the result of the Client's receipt of services, whether caused by the negligence of the Client or otherwise.
8. Governing Law and Venue
This Agreement shall be governed by and construed in accordance with the laws of the state in which the Provider operates, without regard to its conflict-of-law principles. Any dispute arising under this Agreement shall be brought exclusively in the state or federal courts located in that state.
9. Data Privacy and Communications
The Client consents to the Provider collecting and storing the personal information provided herein for the purposes of service delivery, scheduling, and follow-up care. Information will not be sold to third parties. The Client may request access to or deletion of their records consistent with applicable law.
10. Severability and Entire Agreement
If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect. This document constitutes the entire agreement between the parties regarding its subject matter and supersedes all prior understandings, whether written or oral.
The Client affirms they are at least 18 years of age (or the parent/legal guardian of a minor participant), have had the opportunity to ask questions, and sign this release freely.
Client signature, printed name and date, and (for a minor) the parent or guardian's signature.