Computerized Electrodermal Screening is a form of bio-energetic science. This test is non-invasive and painless. It measures the energy fields within the body. The science of computerized electrodermal testing is based on physics, not chemistry. I understand the Orion System is not meant to diagnose, treat or cure disease. This procedure is not intended to take the place of any conventional medical test or diagnostic procedure. At no time will there be any implied or stated indications to discontinue care under the direction of a licensed veterinarian.

By signing this form, I am voluntarily willing to have my pet undergo this procedure. I am doing this with full knowledge that I am acting as his/her own health care provider and take responsibility as such. I understand that the testing procedure and services rendered are not licensed by the State of Washington. I also understand that Joyce Tasker is not a licensed healthcare professional and I hold her harmless without exception. I understand that it is my right at anytime to discontinue these services.

I have fully read and understand the above information, my rights and responsibilities and hereby give my consent.

Name: __________________________________________________________________

Date: __________________________________________________________________

Signature: ______________________________________________________________

Sig. of Parent or Guardian: _________________________________________________