Customer Intake Form

I acknowledge that I am voluntarily participating in the fitness program(s) provided by FORGED Amputee Wellness. I understand that physical exercise, by its very nature, carries with it certain inherent risks, including but not limited to physical injury, strain, discomfort, and even the possibility of serious injury or death. By signing up for this program I hereby assume all risks and responsibility for any such injuries or other medical incidents and will not hold FORGED liable for any of the above.

By signing up for Forged Amputee Wellness account, you consent to the collection, storage, and use of the information you provide to deliver personalized exercise programming, wellness services, educational content, progress tracking, and communications related to your participation.

If you enrolled through a participating prosthetic clinic, you authorize Forged Amputee Wellness to share relevant information regarding your participation, exercise adherence, progress, patient-reported outcomes, and other wellness-related information with your referring prosthetic clinic for the purpose of coordinating your care and supporting your long-term health and mobility.

Forged Amputee Wellness will not sell your personal information or disclose it to third parties for marketing purposes without your separate authorization, except as required or permitted by applicable law. Your information will be maintained using reasonable administrative, technical, and physical safeguards designed to protect your privacy.

You may withdraw your consent for future information sharing at any time by contacting Forged Amputee Wellness. Withdrawal of consent will not affect information already shared or otherwise permitted by law.