We look forward to providing you a demonstration of the technology offered at First Alternatives! Please complete this waiver form before

proceeding to a demonstration

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Please list any active medications that you are taking

Please list any scars and their locations that you might have

Waiver of Liability *

I understand that Avazzia devices impart electrical frequencies into the body. I have truthfully answered the above list of contra-indications for this therapy. Avazzia, Axiom h2, Look25, or QRS does not prescribe medical treatments or diagnoses. It is recommended that I see a physician for any physical ailment that I may have. I have stated all my known medical limitations. Considering the treatment offered, I agree that I will not institute any suit or claim against Avazzia, axiomh2, axiomh2 global, First Alternatives, FA Better Body, their representatives, or practitioners for any damage, loss, or injury to either person or property. I am in good health and have no physical limitations, which should affect my safe use of the devices. I additionally Authorize FA with Photo rights for distributing any pictures without my name for marketing purposes if appropriate with option to remove upon request. I am at least 18 years of age and otherwise legally competent to sign this agreement; This release shall be effective and binding upon signing.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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First Alternatives

First Alternatives

Hours 9 am - 5 pm EST

[email protected]

Fax : 772-872-6620

For Rep inquiries [email protected]

Prescriptions to [email protected]