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

First Alternative Therapies

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Office:  954-789-2097
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First Alternatives Representative Portal

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Brendan@firstalternativecare.com

First Alternative Care
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www.firstalterantivecare.com

info@firstalternativecare.com

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