E.W. Myofascial Therapies (“EWMT”) uses a variety of procedures and modalities, including myofascial release, to try and improve your function. As with all forms of medical treatment, there are benefits and risks involved the therapy and treatment provided by EWMT.

Physical responses to a specific treatment can vary widely from person to person, it is not always possible to accurately predict your individual response to a certain therapy modality. Therefore, EWMT is not able to precisely guarantee what your reactions to a particular treatment might be, nor can EWMT guarantee that its treatment will help the condition for which you are seeking treatment. There is also a risk that your treatment may cause pain or injury, or may aggravate previously existing conditions.

You have the right to ask your physical therapist at EWMT what type of treatment is planned based on your history, diagnosis, symptoms, and testing results. You may also discuss what potential risks and benefits exist for a specific treatment. You have the right to decline any portion of your treatment at any time during your treatment.

Therapeutic exercises are an integral part of most physical therapy treatment plans. Exercise has inherent physical risks associated with it. If you have any questions regarding the type of exercise you are performing and any specific risks associated with your exercises, your EWMT therapist will be glad to answer them.


  • I acknowledge that my treatment program has been explained by E.W. Myofascial Therapies, and all of my questions have been answered to my satisfaction. I hereby accept full and complete responsibility for my health and conditions thereof related.
  • I acknowledge that no one affiliated with, or owned or employed by, E.W. Myofascial Therapies has made promises or treatment claims to me or anyone representing me regarding the treatment, procedures, modalities and/or use of devices or equipment related to my treatment at E.W. Myofascial Therapies.
  • I understand the risks associated with treatment, procedures, and modalities offered and used at E.W. Myofascial Therapies, and I wish to proceed.