Cryotherapy Questionnaire and Waiver Mobile App

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The first sheet covers patient information, any medications and allergies, and several lists of ailments, and conditions. Conditions include: Venereal Disease, Seizures, Rheumatic Fever, Shortness of Breath, Asthma, Heart Murmur, Glaucoma , Heart Valve Disease, High Blood Pressure, Cancer, and Low Blood Pressure. The second sheet includes check boxes for statements like: "I am fully aware of the risks and hazards connected with the use of the Equipment, including the risk of physical injury or disability as the result of such injury, and I am voluntarily participating in said Equipment usage, and entering the above named premises to engage in such usage. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury that may be sustained, or any loss or damage to property as a result of being engaged in such an activity. I further hereby agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs that may incur due to the use of Equipment by me." Signature boxes are also available.

Industry: Health Care & Social Services General Health Care & Social Services

  • Apple
    iPhone, iPad
  • Android
    Android
  • Window
    Windows

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I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.

Dave Kramer

PennLine Service

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