I (the undersigned) understand that the services provided represent a non-medical approach to wellness. I understand that the services provided are limited to guidance on diet, lifestyle, and/or supplementation and that these are not medical services.
I understand that the services are not provided by a licensed physician or other licensed health care practitioner,and that the individual(s) rendering services are only acting as a consultant and facilitator.
I understand that the individual(s) rendering services will not diagnose, prescribe, attempt to prevent, or treat any medical condition, but will only provide guidance for the body to improve and maintain itself.
I also understand that consultations are based, in part, on the information I provide about myself, and therefore certify that all information provided about my health conditions and lifestyle is accurate to the best of my knowledge.
I acknowledge and agree to consult my physician or other licensed health care practitioner, for medical emergencies, acute viral, bacterial, or other physical/biochemical diseases, and any other condition that requires medical attention.
Finally, I confirm that I am at least 18 years of age or am the parent or legal guardian of the client (named below) receiving services and am answering this form on his or her behalf. I am fully competent to make my own health care decisions or to make such decisions on behalf of the client for whom I am signing.
I have read and understood this “Client Acknowledgment.”