ULTRAMAX

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I confirm that if the patient is under 18 years of age, I am the patient's parent or legal guardian, or I have obtained the parent or legal guardian's consent to schedule this appointment.

DISCLAIMER

The result of ancillary diagnostic procedures serve as supportive information and should not be used as the sole basis for diagnosis Correlation with clinical findings and evaluation by a licensed physician strongly advised.

	I hereby confirm that I have read and understood the above disclaimer and information. I voluntarity consent to undergo the indicated medical procedures and agree that the result will be interpreted by a linsed physician in correlation with the my clinical finding.
	I understand that due to the high volume of patients, there may be a longer waiting time. I am willing to wait for my turn and understand that patients will be accommodated according to the clinic’s queueing system.