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Appointment Request Form

We accept cash and insurance for your convenience.

WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT

CA Endurance and Sports Physical Therapy

I. ACKNOWLEDGMENT AND ASSUMPTION OF RISKS

I, the undersigned client, acknowledge and understand that engaging in physical therapy, rehabilitation, and athletic training services with CA Endurance and Sports Physical Therapy ("the Clinic") involves inherent risks, including but not limited to:

  • Muscle strains, sprains, or tears

  • Joint injuries, dislocations, or fractures

  • Abrasions, bruises, or cuts

  • Cardiovascular events, including heart attack or stroke

  • Fainting or dizziness

  • Worsening of a pre-existing condition

  • Other physical injuries or complications

I understand that these risks may be caused by my own actions, the actions of others, or by the negligence of the Clinic, its owners, agents, employees, or contractors.

I voluntarily assume all risks, both known and unknown, associated with my participation in all physical therapy, rehabilitation, and athletic training services provided by the Clinic. My participation is purely voluntary, and I elect to participate despite the risks.

II. WAIVER AND RELEASE OF LIABILITY

In consideration of being permitted to participate in the services provided by the Clinic, I hereby waive, release, and discharge the Clinic, its owners, officers, employees, agents, and contractors from any and all claims, liabilities, demands, actions, and causes of action of any kind whatsoever arising from or related to any loss, damage, or injury, including death, that may be sustained by me or my property while participating in the services.

This waiver and release extends to all claims, whether arising from the ordinary negligence of the Clinic, its owners, employees, agents, or contractors, or from any other cause. I understand and agree that this is a full and complete waiver of any legal rights I may have to seek compensation from the Clinic for any injuries or damages, and I am signing this document of my own free will.

III. INDEMNIFICATION

I agree to indemnify, defend, and hold harmless the Clinic, its owners, officers, employees, agents, and contractors from any and all claims, liabilities, demands, actions, and causes of action, including reasonable attorney’s fees, arising out of my participation in the services, whether such claims are brought by me, my family, my estate, or any other third party.

IV. PHYSICAL CONDITION

I certify that I am in good physical condition and have no medical conditions that would prevent me from safely participating in the physical therapy, rehabilitation, and athletic training services provided by the Clinic. I have been advised to, and have been given the opportunity to, seek advice from my physician or other medical professional regarding my participation in these services. I will inform the Clinic of any changes to my health or physical condition that may affect my ability to participate.

V. JURISDICTION

This agreement shall be governed by and construed in accordance with the laws of the State of California, and any legal action or proceeding related to this agreement shall be brought exclusively in the courts of Santa Clara County, California.

VI. SEVERABILITY

I agree that if any portion of this agreement is found to be unenforceable, the remaining portions shall remain in full force and effect.

I have read this entire agreement carefully, I understand it fully, and I am aware that by signing this document I am waiving certain legal rights, including the right to sue the Clinic.