Agreement Form

(An Agreement Form and Questionnaire must be completed and submitted to us before any evaluations can be performed)

AGREEMENT FORM

My objective is to analyze your situation to identify areas of physical stress that may be caused by your present arrangement or to the usage of your equipment, workstation, tools, etc., and to show you ways to rearrange/adapt your environment or the manner in which it is used to alleviate unnecessary physical stress that should result in a more comfortable situation.

This assessment is not meant to be a substitute for a health care provider, and is not intended to cure, or even prevent, any type of disease, disorder, injury, or illness.

By submitting this form, I agree that I understand the objective of the ergonomic assessment that is defined above. Submit below and you will then be brought to the questionnaire page.

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