I certify that the preceding medical, medication and personal history statements are true and correct. I am aware that it is my responsibility to inform Dr. Taylor, Yvonne Alvarez RN, or Jacquie Bartlett RN of my current medical or health conditions and to update this history. A current medical history is essential to execute appropriate treatment procedures. I agree to receive treatment from Dr. Taylor, Yvonne Alvarez RN, or Jacquie Bartlett RN.
Medical Director - Dr. Frank DiMotta, Jeff McKinley DO