Myotronics Continuing Education Consent Form

 During the course you will be using Myotronics equipment for educational purposes.  If you have any of the following contraindications, you will not be able to TENs.

 

  • Pregnant

  • On demand cardiac pacemaker

  • Over or in the proximity of cancerous lesions

  • Temporal Arteritis

  • Further care should be taken if the participant has suspected or diagnosed epilepsy, heart problems, or other implanted medical devices such as cochlear hearing aids, screws, plates or stunts.

 

If you have any other concerns or medical conditions, please consult with the lecturer prior to TENSing. 

Myotronics seminars, courses and events are recorded for consistency and marketing purposes.

 

I hereby consent and authorize an employee or agent of Myotronics to take photographs or motion pictures of me; or to produce videotapes, audiotapes, or other types of media productions that capture my name, voice, and/or image (any of the foregoing types of media are called the “Materials” in this Consent and Release form).

I authorize Myotronics to copyright the Materials, and I authorize Myotronics to use, reuse, copy, publish, display, exhibit, reproduce, and distribute the Materials in any educational or promotional materials or other forms of media, which may include, but are not limited to journals, catalogs, articles, magazines, recruiting brochures, websites or publications, electronic or otherwise, without further notifying me.

Zoom ID(s) to be used:

Attendee Signatures

Signature

Signature

Signature

Address:

5870 S. 194th Street

Kent, WA 98032-2125

Phone:

(206)243-4214 or (800)426-0316

Email:

info@myotronics.com

Fax:

(206)243-3625

A Division of Myotronics-Noromed, Inc.
Leading in Musculoskeletal Evaluation Technologies Since 1966

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