Reignite Chiro - STEMWAVE New Patient Form

What are your goals and/or expectations with starting Stemwave? (Think 1 month from now to 3 months from now.)
RISKS OF TREATMENT: There may be temporary pain 7/or soreness. This typically resolves within hours or 1-2 days. CONSENT TO TREAT: I hereby consent to authorize the application of Stemwave treatment for the above stated issues on myself or child. I fully understand the nature of Stemwave treatment because I have researched the treatment option &/or the treatment has been fully explained to me by the the treating chiropractor/staff. I confirm that upon entering the facility I have been provided the opportunity to have a discussion to clarify any concerns I may have for myself or my child. I authorize that guaranteed results/expectations have not been promised to me. I also understand I am foregoing the opportunity for alternative &/or medical treatments and opting to have Stemwave treatments per my personal discretion.
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In our office, a credit card is required to have on file. If you were to miss your/your child's Stemwave appointment without notifying the office or rescheduling, there will be a $100 fee.
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Your signature indicates you have read and are aware of our no-call/no-show policy.

We look forward to serving you in our office!
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STEMWAVE New Patient Form