• Authorization for the Use of   Photographs, Medical Information and Assignment of Benefits

    Authorization for the Use of Photographs, Medical Information and Assignment of Benefits


  • Authorization for Use of Photographs:

  • Pictures are truly worth a thousand words in showing the positive results of Complete Decongestive Therapy so we hope you will give consent for us to take pictures to share with your doctor and insurance provider.

  • Authorization for Release of Medical Records:

  • Assignment of Benefits:

  •  / /
  • Should be Empty: