Dien Chan Zone is a wellness therapy proven to be helpful for many conditions. It does not replace your Doctors care or advice. Please seek advice from your Doctor for any serious concerns or changes.
I give permission to my therapist to perform the treatment we have discussed and will hold her from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known
allergies or prescription drugs or products I am currently ingesting or using topically.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.