I hereby agree to the above listed equipment being requested and recommended by Dynamic Rehab Group. By signing this document, you acknowledge and understand that once this equipment has been delivered and used following approval (if approved) may not be changed, unless otherwise agreed upon by the equipment supplier.
I acknowledge that the prescription and recommendation of equipment have been collaboratively discussed with me by Dynamic Rehab Group. I confirm that I have been provided with adequate opportunity to trial the recommended equipment, including sufficient duration of use, and to participate in discussions to express my views, preferences, and identified needs.
I acknowledge and accept that my endorsement of the recommended equipment is based on the information available at the time of assessment and trial. I further acknowledge that if my preferences change, or if the equipment becomes unsuitable in the future due to changes in my needs, circumstances, or condition, this does not constitute responsibility or liability on the part of Dynamic Rehab Group or any of its representatives.
The participant confirms that, to the best of their knowledge, they have provided accurate and complete information regarding their medical condition, functional abilities, risks, symptoms, environment, and equipment use requirements. Recommendations are made based on the information disclosed at the time of assessment.
The participant understands that assistive technology may reduce risk and improve function but cannot eliminate all risk of injury, falls, collisions, pressure injuries, mechanical failure, environmental hazards, or other adverse events.
The participant acknowledges that ongoing maintenance, servicing, charging, adjustment, replacement of worn components, and compliance with manufacturer servicing schedules are required to maintain safe operation. Failure to appropriately maintain equipment may affect performance and safety and is not the responsibility of Dynamic Rehab Group.
