In signing this Waiver of Release of Liability, I give permission to Kelly Neumann, PT, DPT, CIDN consent to treat and administer the appropriate intervention to my son/daughter/self that I deem necessary based off of clinical reasoning. I will be notified immediately at above listed number and emergency contact if such an occasion occurs. If unable to reach me, I give permission to do what is in the best interest of my son/daughter until I am notified. I also understand that my insurance company or I will accept all medical expenses.
I am signing this Agreement freely, voluntarily and competently and am at least 18 years of age. I agree to the terms & conditions above.
I understand Kinematics with Kelly, LLC is a privately owned-cashed based clinic and is unable to turn claims into insurance
