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. I have been informed of and understand the contraindications to the requested treatements and agree that I do no have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treamtent to allow them to adjust accordingly. I agree to waive all liabilities toward my technician and the employer of any injury or damages incurred due to any misrepresentation of my health history.