Consent Form

Before you choose to use the services of a Nutritional Therapist, please read the following information FULLY AND CAREFULLY.

GOAL: Our basic goal is to encourage people to become knowledgeable and responsible for their health, and to bring it to a personal optimum level. Nutritional therapy is designed to improve your health but is not designed to treat any specific disease or medical condition. Reaching the goal of optimum health, absent other non-nutritional complicating factors, requires a sincere commitment from you, lifestyle changes, and a positive attitude. A Nutritional Therapist is trained to evaluate your nutritional needs and make recommendations of dietary change and nutritional supplements. A Nutritional Therapist is not trained to provide medical diagnoses, and no comment or recommendation should be construed as being a medical diagnosis. Since every human being is unique, we cannot guarantee any specific result from our programs.

HEALTH CONCERNS: If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider. A Nutritional Therapist is not a substitute for your family physician or other appropriate healthcare providers. A Nutritional Therapist is not trained nor licensed to diagnose or treat pathological conditions, illnesses, injuries, or diseases.

If you are under the care of another healthcare provider, you must contact your other healthcare providers and alert them to your use of nutritional supplements. Nutritional therapy may be a beneficial adjunct to more traditional care, and it may also alter your need for medication, so you must always keep your physician informed of changes in your nutritional program.

If you are using medications of any kind, please advise the Nutritional Therapist to discuss any potential interactions between medications and nutritional products with your pharmacist.

If you have any physical or emotional reaction to nutritional therapy, discontinue their use immediately. Contact your Nutritional Therapist to find out if the reaction is adverse or an indication of the natural course of the body's adjustment to the therapy.

COMMUNICATION: Every client is an individual, and it is not possible to determine in advance how your system will react to the supplements you need. It is sometimes necessary to adjust your program as we proceed until your body can accept products geared to correct the imbalance. It is your responsibility to do your part by using your nutrition guidelines, exercise your body and mind sufficiently to bring your emotions into a positive balance, eat a proper diet, get plenty of rest, and learn about nutrition. You must stay in contact with the Nutritional Therapist, so we can let you know what is happening and the best course of action.

You should request your other healthcare provider (if there's any) to contact the Nutritional Therapist for answers to questions they may have regarding nutritional therapy.

LICENSURE: A Nutritional Therapist is not licensed or certified by any state. However, a Nutritional Therapy Practitioner is trained by the Nutritional Therapy Association, Inc. which provides a certificate of completion to students who have successfully met all course requirements, including a written and practical exam. A license to practice Nutritional Therapy is not required in some states. Laws and regulations regarding certification and licensure requirements differ from state to state.

By my/our signature (s) below, I/we confirm that I/we have read and fully understand the above disclaimer, are in complete agreement thereto, and do freely and without duress sign and consent to all terms contained.