Subsequent Treatment Consent Form
I hereby confirm that all information provided in this form is true, accurate, and complete to the best of my knowledge and belief.
I understand that it is my responsibility to inform the business promptly of any changes to my contact information, or medical history as this could have an effect on the course of treatment provided.
By my electronic signature below, I acknowledge that I have read and fully understand this agreement and all the information detailed above. If any information has changed since my last treatment I have made a note of it on this form.