Consent and Release of Liability 

    Personal Information Section

    WAIVER OF LIABILITY 

    I understand the Avazzia device imparts electrical frequencies into the body. I have truthfully answered the above list of contra-indications/cautions for this therapy. Avazzia does not prescribe medical treatments or diagnose. It is recommended that I see a physician for any physical ailment that I may have. I have stated all my known medical limitations. In consideration of the treatment offered to my I agree that I will not institute any suit or claim against Avaz-zia, their representatives their employees, or practitioners for any damage, loss or injury to either person or property. I am in good health and have no physical limitations which would affect my safe use of the devices. I am at least 18 years of age and otherwise legally competent to sign this agreement. This release shall be effective and binding upon me and my assigns.

    OFFICE USE ONLY