"My religious beliefs require that I waive the medical examination and the hearing aid evaluation required by the 'Hearing Aid Dealer and Consumers Act of 1977' for the purchase of a hearing aid. I voluntarily waive the medical examination, notwithstanding the fact that I have been advised by
HEARING AID DISPENSER'S NAME
that my best health interest would be served if I had a medical evaluation by a physician who is an ear specialist."
No registrant shall seek to induce a prospective hearing aid user to execute such a waiver.
D.C. Code § 28-4004