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This Consent for Medical Services (“CONSENT”) specifies the terms and conditions under which, you, the undersigned patient (“PATIENT”) may secure the availability of medical services offered by (“PRACTICE”):
Pure Health & Wellness
6065 N First St, Fresno, CA 93710
This consent applies to the PRACTICE, its agents, employees and physician(s). PATIENT and the PRACTICE hereby enter into this agreement for provision of medical services specified herein (SERVICES). Wherefore, in exchange for consideration, the receipt and sufficiency of which the parties hereby acknowledge the PATIENT and PRACTICE agree as follows:
PATIENT agrees that PRACTICE has not made any claims or statements about results or cures.
Duration of Consent: PATIENT acknowledges the right to revoke this consent at any time except to the extent PRACTICE has already taken action in reliance on it. If PATIENT does not revoke it, this Consent will continue indefinitely. By signing this agreement, the PATIENT acknowledges that PATIENT has read and fully understands the information contained in this agreement. PATIENT agrees that everything in this Consent applies to current and future health care services provided by PRACTICE
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