Please read all of the following information carefully and please don't hesitate to call or speak with us prior to your appointment if you have any questions.

Consent to Treatment

Empowered Mama Physical Therapy & Wellness is a hands-on physical therapy clinic. Though highly specialized, treatment consists primarily of manual therapy techniques and treatment forms that are published or otherwise publicly known. Forms of electrical stimulation, deep tissue massage, therapeutic exercise programs, neuromuscular re-education, myofascial release, myofascial decompression, bone and soft tissue manipulation, as well as other treatment modalities may be used, which may cause bruising and/or periods of increased soreness which may last from 6-72 hours. Your therapist will review your plan of care and discuss these treatment options with you in order for you to provide specific consent. Symptoms may also change and move to other parts of the body. This is not unusual and is rarely a concern; however, please speak with your therapist if you have any questions or concerns. The number of treatments needed and recovery time can vary due to age of injury, number of times injured, age and general health of the patient, and many other contributing factors. 

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Cancellation Policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists' day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, for the first time will be charged 50% of the visit rate to the card of file. All subsequent cancellations or no shows will be charged the full visit rate of $250 to the card on file, even if a package of visits has already been paid for upfront.  If your appointment is rescheduled for later in the week, subject to availability, no charge will be applied. Please note that all appointment cancellations must be made by phone during our office hours to ensure the process is handled efficiently.

If the appointment is on a Monday, you need to cancel by the previous Friday by 12:00 pm; otherwise, you will be charged the full amount of the visit. To cancel a scheduled appointment, you may call the office phone number.

Upon scheduling your first appointment at Empowered Mama PT, an intake form & consent form will be sent to you via email and/or text. In order to ensure that the time with your therapist is maximized, that your appointment runs smoothly,, and that your therapist is able to review any medical history in a timely matter, we require that the intake form & consent form be completed a minimum of 24 hours before your first appointment. If both forms are not completed within this time frame, Empowered Mama PT has the right to cancel the appointment. 

Here at Empowered Mama Physical Therapy & Wellness, we start appointments on time. We believe that your time, as well as our time is extremely valuable. Therefore, we will not keep you waiting extensively for your appointment, unlike many other doctors offices. We also will end on time and conclude each appointment at the 50 minute mark in order to respect the next client coming in. If you are late to your appointment, we are happy to treat you for the remainder of your allotted time. If you wish to cancel your appointment due to being late, our standard cancellation policy will apply.

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Telehealth Consent (Online session) 

I hereby consent, by my own free will, to voluntarily engage in the online/ tele-health consultations, whether in person or through video conferencing through Zoom, Google Meet, or FaceTime.

I give consent to this consultation and associated activities which will be recommended to me for improvement of my pain and overall wellness. I will be given exact instructions regarding the movements and activities I should do to best alleviate the pain I am feeling and dysfunction for which I am seeking help. I have been informed that during my participation in this program, I will be responsible to report honestly about any symptoms such as pain, fatigue, shortness of breath, or ANY abnormal occurrence. I KNOW that it is my complete right to stop any activity at any time as well as it is my obligation to inform the consultant of my symptoms, should any develop. I understand that this program may or may not benefit me, though the goal is to minimize my pain and allow me to function at a more normal level than I currently am. 

BENEFITS EXPECTED: I recognize that involvement in the telehealth/ virtual sessions will allow me to learn ways to move better and teach me techniques to work independently and improve my quality of life. I further understand that if I closely follow the program's instructions, I should improve my activity levels after 3-6 sessions. Consent to Record: Your telehealth session will be performed via a secured platform. You may have the option to have the session recorded. This serves a few purposes. The session is emailed to you immediately after so that you can review all things performed.

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Photo/Video Consent 

We might ask to video or record photos of you doing exercises or completing a task to be used for informational and promotional marketing material. I authorize the clinic and its associated health professionals to collect and publish photos and/or videos of my treatment.

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