164 Sausalito Blvd.Casselberry, FL 32707
Review of your Body Systems
Please Check ALL issues whether present now or in the past.
pounds of excess Weight within the next
pounds of lean Muscle within the next
By my signature, I understand and acknowledge that the Clinicians / Doctors will treat my presented health issues as they deem necessary. I also understand that all original records and diagnostic studies are the sole property of the clinic and will be maintained in the clinic for the required statutory term. If the patient is a minor, as the parent, guardian or authorized agent, I hereby give permission to the clinic and it’s Clinicians / Doctors to evaluate and provide treatment for the minor patient.