Disclaimer Agreement Name * First Name Last Name Email * 1. Please tick * I understand that the services that I receive at Energy Enhancement Centre do not proclaim to be from a GP or medical clinic, and that nothing share by the staff members should be taken as medical advice. I understand and agree 2. Please tick * I also agree that I am the sole responsible party for my own health nd I can research all of the information about the services rendered and decide what is best for my personal health objective(s). Energy Enhancement Centre and its staff members act with integrity and abide by the principle of "Do No Harm". I have researched the EE system and have deemed it to be safe and desirable to enhance my health at a cellular level and hold no harm to Energy Enhancement Centre, it's staff members, or the EE system itself. No claims are made to guarantee any specific healing or cure for a disease. I also agree that the EE System shall not be touched by clients, pets, or children, and any damage that may occur as a result will be charged to myself, the client. The fee will be between £3500 - £5000 depending on where the installer is coming in order to align the system again. I understand and agree 3. Please list any diagnosed medical conditions or symptoms you are currently experiencing: * Are you taking any of the following? Please tick the boxes that apply. If you are not taking any, please leave blank. Blood thinning medications? Blood pressure medications? Are you diabetic, and/or taking insulin or other blood sugar regulating medications? Taking heart medications? If you answered yes to the tick boxes above: If you answered yes to any of the above questions, by signing this agreement you are aware that you are responsible for having your blood and heart monitored after exposure to the scalar wave therapy to monitor any positive corrections in the blood and/or heart performance which may result in the need to reduce dosages of these medications. Diabetics are responsible for monitoring their blood sugar levels and regulating it as needed. How would you rate your anxiety level prior to services on a scale of 1-10? * How would you rate your level of pain prior to services on a scale of 1-10? * How would you rate your ability to focus prior to services on a scale of 1-10? * How would you rate your joint-swelling prior to services on a scale of 1-10? * Other, on a scale of 1-10? Please state below. Please sign the agreement * By signing this private agreement, I agree that I am solely responsible for making the appropriate decisions for my personal health and hold Energy Enhancement Centre and it's staff members harmless for any result(s) observed from my visit(s) to the EE Scalar Wave System. First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country What is your appointment date? * MM DD YYYY Thank you for filling the form out. This will be stored safely, and none of your details will be shared outside of Energy Enhancement Centre.
