Physical Capability Requirements

Participation in an Opulence Mobile Athletic Recovery, LLC Compression Therapy session involves exposure to vasopneumatic compression for a short period of time. During the compression therapy session, an assistant will be available during the entire duration of your session. Additionally, you are free to terminate treatment at any time.

Contraindications Opulence Mobile Athletic Recovery, LLC Compression Therapy is contraindicated for patients with: acute deep vein thrombosis, severe atherosclerosis or other ischemic vascular diseases, suspect or known acute deep vein thrombosis, severe congestive cardiac failure, congestive heart failure, existing pulmonary edema, existing pulmonary embolism, extreme deformity of the limbs, any local skin or tissue condition which the garments would interfere with such as gangrene, untreated or infected wounds, recent skin graft, and dermatitis; known presence of malignancy in the legs; limb infections, including cellulitis, that have not received antibiotic coverage; presence of lymphangiosarcoma.

Current fractures/breaks, recent surgery. with stitches/sutures, open wounds, contusions, abrasions; known malignancy in arms or legs, limb infections, including untreated cellulitis; presence of lymphangiosarcoma (rare cancer due to long-standing lymphedema of upper/lower extremities)

LIABILITY AND MEDICAL RELEASE AND INDEMNIFICATION AGREEMENT

In consideration of being permitted by Opulence Mobile Athletic Recovery, LLC to participate in their services, I hereby waive any and all claims and damages for personal injury or death which may occur as a result of my participation. I understand and agree that:

1. This release is intended to discharge in advance Opulence Mobile Athletic Recovery, LLC, its officers, officials, employees, agents, and volunteers from and against all liability arising out of or connected in any way with my participation in these activities;

2. Participation may involve risk of injury and may result not only as a result of my actions, negligence or inaction, but also from the action, negligence, or inaction of others, including their owners, officers officials employees, or volunteers and may result from the conditions of the facilities, equipment, or areas where such activities are being conducted;

3. Knowing the risks involved and the contraindications related, I nevertheless chose voluntarily to request permission to participate;

4. I will indemnify and hold harmless Opulence Mobile Athletic Recovery, LLC, its owners, officers, officials, employees, and volunteers from any loss, liability, damage, cost, or expense, including litigation of any form, arising out of or connected in any manner with my participation in such activities;

5. I am in good health and have no physical condition expressed in the ‘Contraindications’ or otherwise which would preclude me from safely participating in such activities;

6. I understand and agree that this release is intended to be as broad and inclusive as permitted under the law of the State in which it is executed and that if any portion of this Hold Harmless, Release and Indemnification Agreement should be determined to be invalid, it is my intent that the remaining provisions shall continue in full force and effect

By signing below, I agree to the following:

My signature constitutes my acknowledgment that (A) I have read, understand, and fully agree to the foregoing CONSENT, (B) the proposed usage of the NormaTec equipment has been satisfactorily explained to me and I have all of the information I desire and (C), I hereby give my authorization and consent. This CONSENT shall stand as long as I use the NormaTec equipment with Opulence Mobile Athletic Recovery, LLC now and in the future. I have read the instructions for proper use of the facilities and do so at my own risk and hereby release Opulence Mobile Athletic Recovery, LLC from any damage or harm that I might incur due to use of the NormaTec equipment.

IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read and understand the foregoing Waiver of Liability, release and Hold Harmless Agreement, I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate, and complete consideration fully intending to be bound by same.

Furthermore, I agree that I will comply with all instructions on the use of the Equipment and that I am using these services at my own risk. DO NOT SIGN UNLESS YOU HAVE READ AND THOROUGHLY UNDERSTAND THIS FORM. You have the right to withdraw consent for this procedure at any time before it is performed. Minors require a parent/guardian signature. Patient or Authorized Representative
Top of Form