737-200-2783

Treatment Liability Waiver

Contraindications:
Do not use Cryotherapy or other modalities if you have any of the following conditions:
• Uncontrolled high blood pressure
• Cold Allergy
• Prior heart attack
• Open sores
• Unstable chest pain
• Nerve pain in feet or legs
• Disease of blood vessels
• Pregnancy
• History of blood clots

Consult with your doctor or medical advisor if you have questions as to whether these modalities are right for you.
BY ACCEPTING THIS AGREEMENT YOU CONFIRM TO [Round Rock Acupuncture PLLC DBA The Point Wellness,] (THE "COMPANY") FOR THE BENEFIT OF THE RELEASED PARTIES (AS LATER DEFINED) THAT YOU HAVE CAREFULLY READ BOTH PAGES OF THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS, VOLUNTARILY AGREE TO EACH OF ITS TERMS
AND PROVISIONS, AND SIGN OF YOUR OWN FREE WILL.

Waiver and Release:
1. This is a release of liability and a waiver of certain legal rights.
2. By signing this Agreement you:
a. acknowledge that use  of all modalities involve risk of bodily injury,
illness, disability. 
b. expressly waive and release any and all claims against Round Rock Acupuncture DBA The Point Wellness

, and their respective officers, directors, employees, agents, affiliates,
successors and assigns (which are collectively referred to as “the Released Parties”),
arising out of or attributable to your use of cryotherapy. You covenant not
to assert any such claims against the Released Parties, and forever release and
discharge the Released Parties from liability for such claims.
c. indemnify and hold harmless the Released Parties from any loss, liability, damage,
cost or expense arising out of or connected in any manner with your use of cryotherapy or other modalities.
d. agree that this waiver and release is intended to be as broad and inclusive as
permitted under law. You specifically acknowledge and agree that this Agreement is not
intended to be a general release subject to limitations and conditions that would
otherwise apply under applicable state law and additionally agree to waive all general
release limitations provided by applicable law.