Dr.Kevin Davison N.D.,L.AcInformed Consent Agreement • February 3rd, 2021 • Hawaii
Contract Type FiledFebruary 3rd, 2021 JurisdictionThis document is a binding agreement (the “Agreement”) between Maui Regenerative Medicine LLC. (“We” “Us” “Our”) and the individual patient whose name and signature appears below (“You” “Yours”). In consideration of the health care service which may be provided to You by Us at the present and at all times in the future. You agree as follows (Your agreement indicated by placing Your initials on the line following each section and by signing in the space provided):