Consent For Treatment & Liability Release Agreement.
This Form Must Be Completed in order to Receive Treatment.
I/Patient or patient’s legal guardian, acknowledge that i voluntarily wish to receive the therapy of Master Hung Nguyen by acupressure, physiotherapy, manual therapeutic massage that he deems appropriate for the treatment of patient’s illness or any method within Mr. Hung’s ability.
In the course of receiving treatment, I understand and accept:
The patient may experience bruises, and pain for several days or longer due to the treatment. These are normal effects of the procedure.
I have read and understand the information provided, and I accept, personally, and on behalf of any relatives treated, the risks noted in that information.
By signing this form, the patient agrees to waive the right to initiate any lawsuits, complaints, or claims for anything that happens to me or my family members related to the medical treatment provided provided by Mr. Hung Nguyen, his assistants or any other individual in organizers of the treatment facility, as well as the owners of the facilities where the treatment takes place.
Pursuant to 18 united states code sections 2510-2521 electronic communications privacy act.
This transmission contains information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any disclosure, photocopying or distribution of these contents is unauthorized and prohibited by law. If you have received this in error, notify the sender immediately and destroy all copies therein.