Consent Forms - ORAL CONSENT - Natural Endocrinology Specialists

ORAL CONSENT

Only for Persons Physically Unable to Provide a Signature Whose
Records are Being Released

I witness that _______________________________________(patient’s name) understood the nature of this release, understood that he/she may orally revoke this consent at any time except to the extent that action has been taken in reliance upon it and freely gave his/her oral consent.

Witness: _________________________________________________________ Date: _______________
Witness: __________________________________________________________ Date: __________________

Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

Phone: 480-687-0054
Fax: 833-605-1101
Email: contact@nesaz.com
Address:
Suite A 109
7500 E. Pinnacle Peak Rd.
Scottsdale, AZ 85255

Hours of Operation:
Mon: 8:30 AM - 4:30 PM
Tue: 8:30 AM - 4:30 PM
Wed: 7:30 AM - 4:30 PM
Thu: 8:30 AM - 4:30 PM
Fri: 8:30 AM - 3:30 PM
Sat-Sun: Closed

This Site may include a variety of features, such as health tips and videos, services provided at Natural Endocrinology Specialists™, our online Supplement store, NESAZ Programs, email, and patient portal services. DISCLAIMER: These statements have not been evaluated by the Food & Drug Administration. These programs and products are not intended to diagnose, treat, cure, or prevent any disease. The information contained herein is for informational purposes. Please be sure to consult your doctor before taking this or any other product/program. Consult your doctor for any health problems or before starting a new program.

ORAL CONSENT

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