Medical History
Release Liability

Are you suffering from a medical condition, illness, or injury; Or taking any medications/supplements
Do you have any allergies to medications or suppliments

*This documentation will be a legal part of your patient health care record with Sun & Sea IV, LLC. Therefore, all information entered by you shall be truthful to the best of your knowledge. By submitting this document, you agree that you have read and completed this form with accurate and complete information to the best of your knowledge; you are agreeing to all consent to treatment and releasing liability of Sun & Sea IV, LLC from accidental injury or illness

*This form must be renewed every 6 months and/or with any change of patient status