I understand that it is my responsibility to fully disclose my past and present medical history and any medication that I have previously or currently taken. I hereby acknowledge that the information I have provided, to my knowledge, is accurate at the time of consultation and it is my responsibility to notify my practitioner(s) at Body in Motion of any change of circumstance.
Although I acknowledge that there are always risks with treatment, I wish to proceed with an initial consultation and any treatment that is recommended. I acknowledge that if I am claiming through an insurance company that I am responsible for paying any excess on the policy and any difference in charges.
I understand that I am responsible for paying for any appointments that I fail to attend directly to the clinic at the full rate.