Patient Member
I hereby consent to voluntarily engage in movement-based programs at InspireHealth. This may include, but is not limited to Exercise Therapy (consultations, programs, group exercise classes), yoga, Qi Gong, Group Strength, and Group Cardio.
I understand that I am required to participate in a consultation with an Exercise Therapist prior to participating in any of these programs. This is to ensure that I understand the appropriate exercises to perform based on my current health status, stage of cancer treatment, cardiorespiratory (heart and lungs) and muscular fitness. I understand that I may be required to participate in an exercise assessment in order to assess my current level of fitness.
Based on assessment and consultation, I will be given personal instructions regarding the amount and kind of exercise I should do. A professionally trained Exercise Therapist will provide leadership to direct my activities, monitor my performance, and otherwise evaluate my effort. The Exercise Therapist will provide any relevant contraindications to exercise and movements specific to the specific programs that I would like to attend.
In order for the Exercise Therapist to provide the most accurate and individualized care, I understand that I am expected to disclose information to the Exercise Therapist about, but not limited to:
- Health status and history
- Cancer treatments (past and present)
- Treatment-related side effects including, but not limited to: lymphedema, fatigue, peripheral neuropathy, pain
- Current medications
- Bone conditions: osteoporosis, osteoarthritis
- Cardiac symptoms: heart rate, blood pressure, chest discomfort or pain, atrial fibrillation, murmurs, palpitations
- Respiratory symptoms: shortness of breath, asthma
- Orthopedic conditions: areas of pain or injury (past and present)
I understand that a failure to disclose relevant health information to the Exercise Therapist and/or Program Instructor may put me at risk for injury and/or exacerbation of symptoms. I recognize that I do this at my own risk, and will not hold InspireHealth, the Exercise Therapist, and/or Program Instructor liable for any event which may occur.
I understand that periodic follow-up and consultation with the Exercise Therapist is encouraged to ensure ongoing success and decrease risk. I understand it is my responsibility to inform the Exercise Therapist or other InspireHealth staff of any symptoms that arise during my time at InspireHealth including during programs or classes. I also understand that the Exercise Therapist and/or Program Instructor may modify, reduce or stop my exercise program if any risk factors emerge. Failure to follow the conditions listed above may result in being asked to leave the program and/or stop attending the program. This is to ensure my safety and benefit.
RISKS
I understand that exercising and performing physical activity may have inherent risks including, but not limited to, shortness of breath, an increased risks of falls and injuries, and exacerbation of symptoms. The response to exercise may vary person to person, and I recognize that InspireHealth staff and program facilitators may not be able to fully predict risks and outcomes. There is also a risk that my participation in InspireHealth movement programs may cause pain or injury, or may aggravate previously existing conditions. I have the right to discuss any concerns with the Exercise Therapist and/or Program Instructor based on my history, diagnosis, symptoms, and personal goals. The Exercise Therapist will discuss potential risks with me. Some potential risks may include:
- Health: strains, sprains, pain, overexertion, dehydration, fatigue
- Premises: falls, collisions with objects, equipment or other people
- Use of Equipment: mechanical failure or malfunction of the equipment, failure to use or operate the equipment correctly or within my own ability
- My conduct and conduct of other persons: may increase the risk of damage, loss or personal injury.
ONLINE PROGRAMMING
I understand that by participating in an online movement-based program (i.e. exercise, yoga, etc.) through InspireHealth, I do so at my own risk. I acknowledge that it is my responsibility to follow the guidelines and parameters set in place by InspireHealth’s staff and the Program Instructor. Failure to do so may put me at risk as outlined above.
