Client Consent & Acknowledgement

Last updated: October 2026

This acknowledgement applies to services provided by Restore Prehabilitation & Recovery (“Restore”).

Each document is included in booking confirmation emails.

Please read each statement carefully. You will be asked to acknowledge each section before receiving services from Restore.

This document should be read alongside Restore’s Privacy Policy and applicable Terms & Conditions.

I understand that:

Restore provides movement assessment, mobility training, strength and capacity development, prehabilitation, exercise programming, Fascial Stretch Therapy, scar therapy and other movement-based services within the training and professional scope of Restore’s practitioners.

Restore’s services are intended to help assess and develop movement capacity, mobility, strength, physical function and related physical qualities.

Restore’s services are not a substitute for medical diagnosis or medical treatment where these are required.

Restore practitioners do not prescribe medication or perform chiropractic, osteopathic or other spinal or skeletal manipulation unless an individual practitioner is separately appropriately qualified and acting within that qualification.

Where something identified during an assessment or session appears to require investigation or treatment outside Restore’s scope, I understand that Restore may recommend that I seek advice from an appropriate health professional.

I acknowledge and understand the above.

I understand that:

I am responsible for providing Restore with information about medical conditions, injuries, surgeries, symptoms, medications or other relevant circumstances that may affect my participation in Restore’s services.

I will inform my practitioner of any significant change in my health, injury status or physical condition that occurs after completing my intake information.

I understand that Restore relies on the information I provide when deciding how to appropriately assess, modify or deliver services.

I acknowledge and agree to provide accurate and relevant information to the best of my knowledge.

I understand that:

Movement assessment, mobility training, strength training, stretching and other physical services may involve physical effort, fatigue, muscular discomfort or temporary soreness.

Some movements, positions or techniques may feel challenging or unfamiliar.

I will tell my practitioner if I experience unexpected pain, significant discomfort, dizziness, shortness of breath, unusual symptoms or anything else that causes concern during a session.

I understand that I can ask for an exercise, assessment or technique to be stopped or modified at any time.

I understand that I may decline or withdraw consent from any part of a session.

I acknowledge and accept the normal physical demands associated with participation and agree to communicate with my practitioner where appropriate.

I understand that:

Some Restore services involve hands-on assessment, movement guidance, stretching, manual contact or practitioner-assisted movement.

Depending on the service being provided, a practitioner may need to make physical contact with areas of my body to assess movement or tissue; position or stabilise a joint or body region; assist movement; provide resistance; perform Fascial Stretch Therapy; provide Scar Therapy; or otherwise deliver the service being undertaken.

Where clinically or practically appropriate, this may involve direct skin-to-skin contact.

Restore practitioners will explain relevant hands-on contact where required and will respect appropriate professional boundaries.

I may ask questions, request that contact is modified or stopped, or decline a particular technique at any time.

My acknowledgement of this waiver does not mean that I am giving unrestricted consent to physical contact. Consent remains specific to the service being performed and can be withdrawn at any time.

I acknowledge and understand that Restore services may involve appropriate hands-on and skin-to-skin contact.

I understand that:

For most Restore assessments and training sessions, I am expected to wear appropriate gym clothing that allows my practitioner to clearly observe and assess movement.

Suitable clothing includes:

• Shorts and a T-shirt or fitted training top; or
• Leggings and a T-shirt or fitted training top.

Loose, restrictive, bulky or otherwise inappropriate clothing may prevent Restore from carrying out an assessment or service safely or effectively.

For some assessments, Restore may require shorts rather than leggings where clearer observation of the knees, lower legs or other body regions is necessary.

I may also be asked to remove shoes, socks, jewellery, watches or other items where necessary for an assessment or service.

Certain services, including Fascial Stretch Therapy and Scar Therapy, may have different or more specific clothing requirements. These will be explained to me before the appointment where relevant.

If I arrive in clothing that prevents Restore from safely or appropriately carrying out the booked assessment or service, the session will be cancelled and rescheduled, and I will be charged the full cost of the cancelled session.

I acknowledge and agree to arrive appropriately dressed for my appointment and understand that failure to do so may result in the full session fee being charged.

I understand that:

Restore may use assessment technology as part of a Movement Profile or other physical assessment.

This may include VALD HumanTrak, which allows Restore to collect and analyse movement and physical-performance measurements such as movement, mobility, joint range of motion, balance and functional performance.

Results from these assessments may form part of my Restore client record and may be used to assess my current movement or physical capacity, identify areas that may benefit from training, help guide recommendations or programming, monitor changes over time, and compare future assessment results.

I understand that assessment information is used as one source of information within Restore’s assessment process and is not, by itself, a medical diagnosis.

I acknowledge and understand the use of movement-assessment technology as part of Restore’s services.

I understand that:

Restore may collect personal and health information during my assessment and services, including movement and physical-performance information generated through VALD HumanTrak.

Information associated with me forms part of my Restore client information and is handled in accordance with Restore’s Privacy Policy.

VALD processes HumanTrak information on Restore’s behalf in order to provide and support the HumanTrak service.

VALD may process identifiable information where necessary to provide, maintain, secure and improve its services and to convert information into a de-identified or anonymised form.

Analytics, benchmarking and normative reporting undertaken by VALD use de-identified or anonymised information rather than identifiable client information.

Information processed through VALD may be hosted or accessed outside New Zealand, subject to contractual privacy and security safeguards.

I have been given access to Restore’s Privacy Policy, which explains in greater detail how Restore collects, uses, stores, processes and protects personal information and how I may request access to or correction of my information.

I acknowledge that I have read and understood how my personal and assessment information may be collected and processed as part of Restore’s services.

I understand that:

If I am participating in an assessment arranged through a team, club, employer or other organisation, I understand that:

• My individual assessment results and identifiable personal or health information remain information about me.
• The organisation arranging or paying for the assessment does not automatically receive my complete individual assessment record or health information.
• Restore may provide the organisation with de-identified or aggregated information about the group where individual participants cannot reasonably be identified.
• If Restore proposes to provide my identifiable individual results to a coach, team, club, employer or other third party, I will be informed what information is proposed to be shared and the purpose for sharing it.
• Unless another lawful basis applies, identifiable information will only be shared where I have authorised Restore to do so.

I acknowledge and understand how my information will be handled when participating in a team, club or group assessment.

Restore collects and manages personal and health information in accordance with its Privacy Policy.

The Privacy Policy explains what information Restore collects; why it is collected; how it is used; the third-party service providers involved; overseas processing; security and retention; access and correction rights; HumanTrak and VALD processing; and how to contact Restore’s Privacy Officer.

The current Privacy Policy is available on Restore’s website and may also be provided to me on request.

I acknowledge that I have been given access to Restore’s Privacy Policy.

I understand that:

Appointments and services are subject to Restore’s cancellation, rescheduling and attendance requirements as set out in the applicable Terms & Conditions and communicated during booking.

Late cancellation, non-attendance or arriving too late for Restore to reasonably deliver the booked service may result in a fee in accordance with those Terms & Conditions.

Restore may also need to cancel, postpone or modify a session where it cannot safely or reasonably provide the booked service.

I acknowledge that I am responsible for reviewing and complying with the cancellation and attendance terms applicable to my booking.

I understand that:

I understand that I am responsible for payment for services I purchase or receive from Restore in accordance with the prices, payment arrangements and Terms & Conditions applicable to those services.

I acknowledge my responsibility for amounts properly payable to Restore.

I understand that:

I am encouraged to ask questions before, during or after a Restore service if I do not understand an assessment, exercise, technique, recommendation or aspect of the service.

I may ask for further explanation before deciding whether to participate.

I can decline or stop an assessment, exercise or technique at any time.

I acknowledge that I have had the opportunity to ask questions and understand that my participation remains voluntary.

By completing this acknowledgement, I confirm that:

• I have read and understood the statements above;
• I have had the opportunity to ask questions where required;
• The information I have provided to Restore is accurate to the best of my knowledge;
• I understand the nature of the services in which I am participating;
• I understand that physical activity and hands-on services can involve some inherent physical risk and that outcomes cannot be guaranteed;
• I understand that I may withdraw consent from an assessment, exercise or technique at any time;
• I acknowledge the collection and processing of information as described above and in Restore’s Privacy Policy; and
• I agree to comply with Restore’s applicable Terms & Conditions.

Nothing in this acknowledgement excludes or limits any rights or remedies that cannot lawfully be excluded or limited under New Zealand law.

I acknowledge and agree.