Patient Details

—Please choose an option—MaleFemaleOther / Prefer not to say

Medical Information

Package Selection

—Please choose an option—Single Session20-Session Package (Valid for 27 days)30-Session Package (Valid for 45 days)

Clinic Policy Acknowledgement

I have read and agree to Team Aceso’s Clinic Policy Notice

Attendance & Cancellations: Sessions missed without prior information will be counted as completed. Inform at least 30 minutes before scheduled appointments if unable to attend.

Session Validity:

• 20-session package: Must be completed within 27 days.

• 30-session package: Must be completed within 45 days.

• Refund Policy: All payments are non-refundable.