Client Intake Form

Patient Intake & Consent Form

Please complete the form prior to your appointment.

Medications & Allergies

Past Medical History

By submitting this form, I authorize and give consent to True Freedom Therapy and its staff for evaluation and treatment using Soft Wave Therapy (also known as Acoustic Wave Therapy).

I understand that there are risks associated with any medical procedure or treatment, and I acknowledge that it is impossible for True Freedom Therapy or its staff to guarantee specific results.

I agree to follow the proposed treatment and recommended schedule without deviation. I also agree to faithfully disclose my complete medical history including - but not limited to - all prescription medications, over-the-counter medications, recreational substances and past surgeries.

I release True Freedom Therapy and its medical and non-medical staff of any and all liability. By signing below, I confirm that I have read and fully understand this form in its entirety.