My Diet Solutions.com - Registration

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Registration
Medical History Form: When you have completed filling out the form, and have read the Terms and Conditions link, click the Send Registration button to create your account.
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	Accept Terms and Conditions
By checking this box and registering for an account with MyDietSolutions.com, I agree to the "Patient Informed Consent for Injections" terms and certify that I have accurately completed this Medical History Form. I understand that my order will not be processed without properly completed forms and that I will be responsible for any fees incurred should a refund become necessary due to missing or incomplete forms. Read Patient Informed Consent for Injections here.