Please be advised that the information provided in this form will be used for the purpose of assessing your wellness needs. By submitting this form you acknowledge that the information provided is accurate to the best of your knowledge. Furthermore, you understand that the services provided at Ascension are not a substitute for medical advice or treatment. It is recommended that you consult with a healthcare professional for any medical concerns. You must be 18 or older to use the services offered at Ascension. If you are pregnant, or think you may be, you are not permitted to use the services offered. I knowingly and voluntarily waive any and all claims against Ascension that may result from any and all injuries and/or damages that I sustain as a result of any and all activities that I participate in at Ascension. I have read and consent to the terms outlined in this disclaimer. 

By signing below, I acknowledge that I have provided accurate information to the best of my knowledge and understand that this information will be used to customize my experience at Ascension.