Acoustic Wave Therapy Candidate Form

  • Date Format: MM slash DD slash YYYY
  • By signing this form, I authorize and give my consent to WaveTech Therapy and its Medical Doctors, and such other physicians, nurses, associates, technicians, as well as any other health care persons for evaluation and treatment of my Acoustic Wave Therapy program (also known as Soft Waves) while under the supervision of WaveTech Therapy's care. I understand and am fully satisfied with the knowledge that there are risks to any medical procedure, treatment, and therapy; including the proposed treatment for Soft Waves both known and unknown and that it is not possible to guarantee or give assurance of a successful result. I acknowledge and accept these known and unknown general risks. I appreciate, understand and agree to follow the proposed treatment and recommended schedule without deviation. I also agree to faithfully disclose my complete medical history, all prescription and nonprescription medications that I am currently taking or plan to take during my treatments. Also all over the counter medications, recreational drugs or social substances, herbs, and extracts. And I agree to completely follow the recommendations. I also understand that the use of "social substances" such as tobacco, "Street drugs," alcohol, and other types of otherwise non-described "social substances" may affect my therapy. I release WaveTech Therapy medical staff of any and all liability. I confirm that I have read this form in its entirety or it has been read to me if I have been unable to read it. I understand there are risks associated with participating in any program offered by WaveTech Therapy.

  • Date Format: MM slash DD slash YYYY
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