For my records, I need to confirm that you clearly understand all of the questions asked and agree with what has been written. If there is anything you do not understand, please
To the best of my knowledge, the information I have given is true, and I have not withheld any information concerning my health. I will keep (name of therapist) updated on my health should there be any changes to answers given. I understand there is a possibility I may experience some minor reactions as my body adjusts to the treatment.
I understand that the therapist does not diagnose illness, disease or any other physical or
mental condition. I understand that this treatment is not a substitute for medical
examination, diagnosis, or treatment. While I recognise that all due care will be taken by the therapist, I am aware that my participation in the treatment is voluntary.