Waiver for Diet Mobile App

This mobile form is very simple and it's used for patients that don't want to follow their doctor-prescribed diet, such as recommended vitamin and supplement intake, carbs, ingredients, etc. The patient, or their legal guardian, signs a waiver and release on all areas to make it clear that they will follow their own diet and that they understand the risks of doing so. There is also a field where the patient releases The Facility of all liability when declining the prescribed medical diet and dietary restrictions. When the patient is done filling out the diet waiver form on the app, an emailed submission is sent to the admin who can view the submission as a PDF. This waiver for diet template is intended for medical and health service providers, as well as their patients.

Industry: Health Care & Social Services Diet & Nutrition

  • Apple
    iPhone, iPad
  • Android
  • Window

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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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