I hereby declare that / 我在此声明:

1. All information given by me are true and correct and I undertake to inform the therapist of any changes therein, immediately. 我所提供的资料都是正确无误的,我承诺如果身体状况有变更，会在进行理疗前立即知会理疗师。
2. I affirm that I understood the treatment that I'm to receive and I am fully aware of and accept any possible sign of recovery reactions (ie. red spot, blister, etc.) that may occur after Gua Sha or moxibustion therapy. 我确认我已理解我将接受的理疗,并完全清楚及接受因刮痧或艾灸理疗可能出现的出痧、水泡或任何可能的排病现象。
3. I hereby give consent to proceed with the therapies without confirmation from my own GP or Consultant. 我确认我愿意在未经我的医生或顾问确认的情况下进行理疗。
4. I hereby authorize the therapist and the assistants to perform upon me the suggested treatment. 我特此授权我的理疗师或指定的助手对我执行理疗程序。