I have carefully read and understood this questionnaire and filled this form to the best of my knowledge.
I am aware that this is a private health clinic, and I will be charged a consultation fee, and any additional treatments or tests will incur further charges, which I will be made aware of before undertaking. If I am unsure about costs of my treatment, I will ask for clarification from a member of staff. I will pay the fees I have incurred prior to leaving the clinic. I understand there is no obligation to any treatment or tests after the initial consultation.