ALL-STAR INFUSIONS L.L.C will not share your information with anyone, without written consent to do so, as it is important for us to honor confidentiality between provider and patient. I understand, have read and completed this questionaire truthfully. I agree that this constitutes full disclosure, and that it supercedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or complications from treatments received. I am aware that it is my responsibility to inform the medical staff of my current medical and/or health conditions and to update this history. The treatments I receive are voluntary and I release ALL-STAR INFUSIONS, L.L.C from liability and assume full responsibility thereof.