CONSENT
I hereby consent to voluntarily participate in a Clinical Somatic Education session with Jeralyn Atleson, d/b/a Soma Health Connection. I understand that Clinical Somatic Education is a safe, gentle approach to addressing muscle tension and pain, and that it is not a high-risk, strenuous, or physically demanding activity.
I understand that Clinical Somatic Education is not medical in nature and does not claim to treat, diagnose, or prescribe any disease. I understand that Clinical Somatic Education is movement education, the goal of which is to improve sensory motor awareness, muscle function, physical comfort, and freedom of movement.
I understand that all somatic movements and movement explorations are undertaken voluntarily by myself, and that if any movement is uncomfortable, I will discontinue it and communicate directly with the practitioner.
RELEASE OF LIABILITY
I do hereby waive, release, and forever discharge Jeralyn Atleson, d/b/a Soma Health Connection, from all responsibilities or liabilities for any injuries or damages to myself, including injury or damage caused by negligence or gross negligence. I fully understand that I may injure myself as a result of voluntarily participating in these movement programs, and it is still my desire to participate as indicated herein.
PHYSICAL CONDITION
I hereby represent that I am in good physical condition and do not suffer from any condition, illness, or injury that could be adversely affected by Clinical Somatic Education. I am not relying on Jeralyn Atleson, d/b/a Soma Health Connection, to evaluate this information for medical purposes, and I will rely solely on my physician or other medical professional to advise me concerning such matters. If my physical condition or medication changes, I will inform the practitioner immediately.
CONFIDENTIALITY
I have been informed that the information obtained in this Clinical Somatic Education session will be treated as privileged and confidential and will not be released to others unless my consent is provided.
