Motion Physical Therapy and Coaching, PLLC – Consent to Treat

I hereby consent to voluntarily engage in physical therapy treatment and services deemed necessary by my physical therapist and/or physician. I understand that physical therapy is not an exact science and I acknowledge that no guarantees have been given to me as far as my treatment.
Patient, or person authorized to give consent for patient (name and state relationship) or just (state relationship)*
Electronic Signature*
By typing your name in the space below you are providing an "electronic signature" and it indicates your approval of the information contained in this electronic form.
Date Signed*
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