Medical History Disclaimer
I understand that providing incomplete or inaccurate information about my medical history or current health condition can impact my treatment outcomes. Prime Health is not responsible for any issues arising from misinformation or omissions.
Consent and Acknowledgment
By signing below, I confirm that:
I have read and understood the contents of this form.
I agree to the terms outlined above, including the use of my images or videos for marketing and educational purposes.
I understand the importance of providing honest and accurate information.
I release Prime Health from responsibility for any outcomes resulting from inaccurate information I may provide.
I understand that providing valid insurance or a payment method is required before treatment begins.
Honesty and Confidentiality Agreement
By signing below, I acknowledge and agree to the following:
I will provide honest and accurate information about my medical history, lifestyle, and treatment goals.
Any false or misleading information I provide may affect the results of my treatment, and I understand that Prime Health will not be held responsible for any negative outcomes caused by my inaccuracies.
All conversations and medical details shared during consultations will be kept confidential and used solely for medical and treatment purposes.
I will not use any discussions, recommendations, or advice provided by Prime Health consultants for personal disputes or legal action against the clinic or its staff.
Consent for Use of Media
By signing this form, I authorize Prime Health to use any images or videos taken during my treatment for purposes such as advertising, marketing, or educational materials. I understand:
I will not receive any payment, commission, or compensation for the use of my media.
Prime Health does not need to seek additional permission from me after I have signed this consent.
These materials will be used professionally and in alignment with Prime Health’s goals.