EFL Table Work Intake & Consent

For all table work, including athlete mobility, Private Mobility Lab and Elite Recovery Lab. Complete before your first table-work session and renew annually; discuss any changes with your therapist at every visit.

Participant Information

Legal first name

Legal last name

Phone

Date of birth

Month

Day

Year

Is participant under 18?

Yes

Emergency Contact

Emergency contact name

Emergency contact phone

Session Information

Session goals and areas of concern

Health history

Guardian Information

Informed Consent

Hands-on therapy is provided only by licensed staff (LMT), strictly within scope of licensure. It may cause temporary discomfort, soreness or bruising. Results are not guaranteed and it is not a substitute for medical treatment. You may request a stop and withdraw consent at any time. If a minor requests a stop, the session pauses immediately.

I have read and understood the information above and consent to the hands-on services discussed with my therapist.

Participant or guardian signature

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Signing date