360 Medical Consent to Treat
Lauren Tortorici, DC | Sharmin Sultana, DC | Louis Angulo, DC | Earvin Paul, DC
Goli Hiekali, PT, DPT | Anna Potapova, PT, DPT | Bahr Rubinstein, DC
I hereby consent to the performance of chiropractic treatment, including but not limited to joint and soft tissue mobilization, physiotherapy modalities, stretching, and therapeutic exercise, by the Doctor of Chiropractic named above and/or other licensed Doctor of Chiropractic who now or in the future work at any of the 360 Medical Consulting’s clinics or offices. By signing below, I agree to the above-named procedures. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment.