In signing this form I acknowledge that this represents an accurate medical history and I will advise of any changes to my medical history in the future. I understand all medical details will be treated with complete professional confidentiality. I have read the privacy document provided by this practice.
Payment is required on the day of treatment. In the event of an account being in default the customer shall be liable for all resulting costs arising from the recovery, which includes the account in full and legal costs including demand costs. Full trading terms and privacy statement are available on our website, or a copy may be provided by reception upon request.
