I hereby consent for my therapist to treat me with Facial Manual Rejuvination therapy for the above noted purposes including such assessments, examinations and techniques, which maybe recommended, by my therapist. I acknowledge that the therapist is not a physician and does not diagnose illness or disease or any other physical or mental disorder. I clearly understand that Facial Manual Rejuvination therapy is not a substitute for a medical examination. It is recommended that I attend my personal physician for any ailments that I may be experiencing. I acknowledge that no assurance or guarantee has been provided to me as to the results of the treatment. I acknowledge that with any treatment there can be risks and those risks have been explained to me and I assume those risks. I acknowledge and understand that the therapist must be fully aware of my existing medical conditions. I have completed my medical history form as provided by my therapist and disclosed to the therapist all of those medical conditions affecting me. The information I have provided is true and complete to the best of my knowledge. In this case, I will not raise any claims to therapist.
FACIAL MANUAL REJUVINATION THERAPY AFTERCARE ADVICE
Firstly, in case of severe pain during the procedure, we ask you to inform about this to measure the intensity and depth of manipulation. Secondly, if after the procedure, pain persists in your face for several days, IT IS NECESSARY FACE (therapist will show and teach how to use some techniques) Finally, it is important to drink more fluids to accelerate toxin removal. By signing this form, I confirm my consent to treatment and intend this consent to cover the treatment discussed with me and such additional treatment as proposed by my therapist from time to time, to deal with my physical condition and for which I have sought treatment. I understand that at any time I may withdraw my consent and treatment will be stopped.