The one paying for the appointment
The loved one at Amica receiving the foot care
– I consent to the Universal Health Hub nurse to provide footcare every 6 to 8 weeks
– I understand and appreciate that I may withdraw my consent, at any time by communicating with Universal Health Hub.
– I understand the purpose of this Consent and that I can refuse to sign it. I acknowledge that I am signing this consent consentwilingly and voluntarily for my loved one and that my consent has not been obtained through misrepresentation or fraud.
-I will be paying the $60 invoice for the regular footcare appointments
Clear Signature
Signature of of PoA