Withdrawal Clinic Patient Agreement

Section 1: The Fine Print

By signing below, you, the patient, acknowledge that you are aware of the risks associated with visiting our clinic. These risks include, but are not limited to:

Section 2: The Fun Part

By signing below, you'll be eligible for:

Section 3: The Legal Mumbo-Jumbo

By signing below, you, the patient, release and hold harmless:

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