par-q form

Name *
Name
Do you currently have any of the following conditions?
Declaration: *
“I the above, have completed the form as fully and accurately as I can. I believe the details to be correct and consent to work with the practitioners within Paradox. I release the practitioner/company from any negligent misrepresentation that may be contained in the form. I accept that exercise I participate in is taken at my own risk. I understand that failure to disclose information requested above may result in adverse side effects, unknown because of this to which I accept full liability/responsibility. I am aware that it is my responsibility to inform the practitioner of my current and ongoing medical or health conditions, and it is essential for the caregiver to execute appropriate treatment procedures. I understand Paradox reserves the right to charge for appointments cancelled or broken without 24 hours notice.”
Date *
Date