Waiver of X-rays and Diagnostic Testing
This is to acknowledge that: Dr. Michael J Trudeau,DC has recommended that x-rays and or diagnostic testing be taken so that a complete study and analysis may be made of
present problem or illness.
I, the undersigned, do not feel that my present problem or illness is serious enough to warrant the use of x-rays or other diagnostic testing, so that a complete study and analysis may be made by Dr. Trudeau. Therefore, Dr. Trudeau is hereby authorized and directed to treat my present problem or illness to the best of his ability without making a complete study and analysis of my present problem or illness.
Should any untoward effects or any further illness or injury develop, directly or indirectly, as a result of such treatment, I shall assume full responsibility. In consideration of Dr. Trudeau’s treatment, treating me at my request without benefit of a complete study and analysis, I do hereby release Dr. Trudeau from all causation, causes of action, and liabilities arising by reason of said treatment, whether here to or hereafter occurring, and whether now known or unknown by the parties hereto.