By signing below, you agree to the following:
I have completed this form to the best of my ability and knowledge and agree to inform the technician of any changes in the above information. / have been informed of and understand the contraindications to the requested treatments and agree that / do not have any condition(s) that would make the requested treatment unsuitable. / will inform the technician of any discomfort / may experience at any time during my treatment to allow them to adjust accordingly. / agree to waive all liabilities toward my technician and the employer for any injury or damages incurred due to any misrepresentation of my health history.