Waiver for Diet

Form Template

This is a Waiver for Diet App, which can be used on any smart device by a patient and health provider.

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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.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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