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Consent Form
Date*
Full Name*
I will strictly follow the diet given by the concerned doctor.
No breaks would be allowed for target based programmer.
Validity period has to be taken care off it cannot be adjusted or extended as per discussed.
If I am irregular in taking the session then there is no replacement of any days or sessions & no guarantee of targeted weight loss.
I can avail of the allotted time for my session only if I come on time. I understand that if I came late will not be given extra time after allotted time of my session.
I have to come with the weight loss of previous session, I would not be eligible for the session if the weight gain is more than 100 gms for weight loss programme & 300 gms for inch loss & U-Lipo sessions.
Sessions would only be effective if regularity and diet is followed as prescribed.
I understand my weight loss can be gradual if I suffer from medical problems such as PCOD, HYPOTHYROIDISM, DIABETES etc.
The management is not responsible for any kind of negligence from the patient regarding diet & the sessions.
I have informed the doctor regarding any previous illnesses, medication that I have/had and I am totally responsible for any consequences happening during my treatment.
I will strictly follow the given instructions by the doctor and the management.
In case of discontinuation of my sittings at any point of time due to my health problems or personal problems, I won't blame any member of UR FITNEST Clinic nor will I get any refund or credit note from UR FITNEST Clinic.
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Signature Of Doctor
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