confirm that I have understood the treatment being rendered and confirm that the above medical information is accurate. I am willing to proceed without confirmation from my primary physician or medical consultant.
You should note that if the Doctor or Therapist is unable to explain to you the contra-indications or is unsure of anything that may apply to a specific condition then they should not treat you without asking you to consult with your primary physician.
It is your responsibility and not that of Rejuvenations Incorporated, or Staff to consult with your primary physician if necessary.
I hereby indemnify Rejuvenations Incorporated, staff and its affiliates against any adverse reaction sustained as a result of the treatment and confirm that all the information I have provided is correct.