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Personal Information

Post-Appointment Confirmation and Consent

Thank you for confirming your appointment. Before proceeding, we would like to gather additional information regarding your preferences for the consultation. Please indicate whether you would like a referral to accompany you, help with note-taking, and whether you agree to join a group chat for follow-up. Your responses will help us ensure a smooth and personalized consultation experience.
Would you like a referral to accompany you during the consultation?
Please let us know if you would like a referral (such as a family member or friend) to accompany you during the consultation and assist with note-taking.
Would you like to have a group chat with your referral and consultant?
If you would like follow-up communication after the consultation, we can create a group chat with your referral and consultant to help guide the process and adjustments for your well-being.
If you have any specific preferences or notes regarding your consultation, please let us know below.
I understand the “Introduction to Consultation” and the Terms and Conditions of services.
I wish to fill out the Consultation Assistance Form.
Clear Signature
Please sign below to confirm your responses and agreement to the terms outlined in this form.