PMA Application

PMA Application - one is required for EVERYONE OVER 18. Plus signing the consent on the email/text sign up on the home page

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Names and Birthdates for all people applying. One must be an adult, children can be listed as well. Each adult over 18 must fill out their own form *

Email to have on file *

contact number *

I have read the disclaimer and PMA guidelines under the disclaimer tab. I understand Angela A Dockter PMA is for educational purposes only and does not diagnose or prescribe and I agree to be educated and informed on all decisions I make regarding my health or that of my minor children and hold Angela A Dockter and her PMA/Company harmless and release of ALL liability and I assume ALL risks and responsibilities re: any education and advice I choose to follow/implement/use. The base goal of Angela's website and services is educational in nature only. TYPE FULL NAME BELOW as acceptance of terms and conditions. *

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