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By Checking I agree to the following: CONSENT FOR SERVICE I knowingly and voluntarily consent to the rendering of Service by the Center of Optimal Restoration, LLC. The term Service shall include, but not be limited to, Exercises that: build the cardio-respiratory system, the musculoskeletal system, and improve body composition. Examples of Exercises may include, but are not limited to, aerobic activities, callisthenic exercises, weight lifting, and flexibility exercises. The term Service may also include soft tissue and/or taping techniques to facilitate relaxation and relief of muscular tension. I agree the described the scope of Services to me in detail and offered me the opportunity to ask questions before the initiation of any Service. If I experience any pain or discomfort during associated with any Service, I agree to immediately inform the Center of Optimal Restoration, LLC I agree that Services should not be construed as a substitute for medical examination, diagnosis, or treatment, and because Services should not be performed under certain conditions, I agree that it is my responsibility to accurately report all of my relevant pre-existing medical conditions to the Center of Optimal Restoration, LLC and answer all of his questions honestly prior to the initiation of Services. I agree to inform the Center of Optimal Restoration, LLC of any changes in my medical profile during today’s and all future sessions, and I waive any claims against the Center of Optimal Restoration, LLC relating to the Services should I fail to do so. I agree that the Center of Optimal Restoration, LLC reserves the right to refuse to perform Service on anyone whom he determines has a condition for which Services are contraindicated and I acknowledge the Center of Optimal Restoration, LLC advised me to seek the advice of my physician prior to the initiation of Services. Finally, I agree that The Center of Optimal Restoration, LLC will terminate all Services immediately if I make any illicit or sexually suggestive remarks or advances. ASSIGNMENT OF BENEFITS I understand that all payments are due to the Center of Optimal Restoration, LLC at the time services are rendered, except when prior arrangements are made. All bills are due and payable in full. All fees are based upon individual services rendered, and may vary from visit to visit depending upon the specific recommendations.