Understand that by signing this form, I am acknowledging that I have been informed about the following procedure/treatment:
I have had an opportunity to review the consent binder provided by the practice regarding this procedure/treatment in its entirety and understand the process and associated risk.
I have had an opportunity to ask the doctor questions about the procedure/treatment and do not need any additional clarification.
I have disclosed my medical history, current medical conditions, current medications and known allergies to the practice.
I acknowledge that I have read this consent form and fully understand it.
Helping you find balance from the inside out is one of our top priorities.