Our guided program runs on the days you pick here. The build-your-own programs below run on fixed days and will set this to match.
Exercise Program Consent, Assumption of Risk & Release
Please read this carefully before you start. It explains the benefits and risks of participating in an exercise program, your rights as a participant, and what we each are responsible for. If anything is unclear, call us at 804-366-4485 before signing — we are happy to walk through it with you.
1. Consent to participate. I consent to participate in an exercise and fitness program provided by Mobile Motion PT, LLC ("Mobile Motion") through its training service. I understand my program may include resistance exercise, bodyweight exercise, mobility and conditioning work, written and video instruction, workout logging, and coach review and feedback on the workouts I log. I understand that this is an exercise program, not physical therapy or medical treatment, and it does not create a patient–therapist relationship . If I develop pain or an injury that needs clinical care, Mobile Motion will help me connect with Cameron Mauzy, PT, DPT for a physical therapy evaluation. I understand that no particular result is guaranteed, and that I may ask questions at any time.
2. Inherent risks of exercise. I understand that exercise, like all physical activity, carries inherent risks that cannot be completely eliminated, even when a program is designed carefully and followed as directed. These risks include: temporary muscle or joint soreness, stiffness, fatigue, or bruising; muscle strains or joint sprains; a temporary increase in pain or aggravation of an existing condition; dizziness or lightheadedness; falls and injuries from falls; changes in blood pressure; and, rarely, more serious events such as a fracture, a cardiovascular event (including heart attack or stroke), or other serious injury. I understand that I will exercise largely on my own, in my own space and with my own equipment, and that these same risks apply there — so I will exercise in a safe, clear space, check my equipment before use, and follow the program as written rather than adding weight or difficulty beyond what it prescribes.
3. My participation is voluntary, and I can stop at any time. I understand that my participation is voluntary. I may skip or modify any exercise, and I may stop any activity at any time, for any reason. Stopping will not be held against me. I agree to note pain or problems in my workout log and to speak up right away if something hurts, feels wrong, or worries me, so my program can be adjusted.
4. Assumption of risk. I have read and understood the risks described above. Knowing those risks, I voluntarily choose to participate in an exercise program at Mobile Motion, and I assume the inherent risks of participating, for myself and, where applicable, on behalf of my minor child or the person for whom I am the legal representative.
5. Release of liability. To the fullest extent permitted by Virginia law, I release and hold harmless Mobile Motion PT, LLC, its owner, and its employees and contractors from any claims, demands, or causes of action arising out of the inherent risks of my participation in the exercise program, as described above. This release does not apply to claims arising from gross negligence or willful misconduct.
6. My duty to share health information. I agree that the answers I gave in the safety screening and on this form are complete and accurate, and I agree to promptly tell Mobile Motion about any changes — including new symptoms, changes in medication, new diagnoses, new injuries, illnesses, surgeries, or hospital visits — because these changes can affect the safety and direction of my program. I understand that withholding or delaying this information could make my participation less safe or less effective.
7. An exercise program is not a substitute for medical care. I understand that this program does not replace care from my physician or other medical providers, and I will keep my physician informed about my condition and activity. I understand that Mobile Motion does not provide emergency care. If I have an emergency — such as chest pain, severe shortness of breath, or sudden weakness — I will call 911 or go to the nearest emergency room.
8. Electronic signature. I agree that checking the agreement box below, typing my full name, and submitting this form counts as my electronic signature on this document, with the same legal effect as a handwritten signature. I understand I may ask for a paper copy of this document at any time.