Cancellation Policy /Consent to treatment
We request a minimum of 24hours advance notice for the cancellation or rescheduling of any appointment.
Failure to do so will result in a FULL FEE CHARGE.
I release and give up any and all rights that I may have against you.
I CERTIFY THAT I HAVE READ AND FULLY UNDERSTOOD THE INFORMATION. I FEEL THAT I HAVE BEEN ADEQUATELY INFORMED REGARDING THE RISKS AND POSSIBLE BENEFITS OF TREATMENT.
I ACKNOWLEDGE THAT NO GUARANTEES HAVE BEEN MADE TO ME CONCERNING THE RESULTS OF THE BELOW STATED PROCEDURES.
| 1.Price per session:————————————– + Tax $ | |
| 2.Price per session:————————————– + Tax $ | |
| 3. Price per session:————————————- + Tax $ | |
| 4. Price per session:————————————- + Tax $ | |
| 5. Price per session:————————————- + Tax $ | |
| 6. Price per session:————————————- + Tax $ | |
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*I HEREBY GIVE MY CONSENT TO LES COURS HYPERBARIC CENTER AND ITS STAFF TO PERFORM THE ABOVE MENTIONED TREATMENTS.
