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DISCLOSURE AND WAIVER OF LIABILITY AGREEMENT
By checking the box I acknowledge that I have read and understand the contents of this liability agreement.
1. Brenda Bennett is a nutrition consultant and does not function as a physician, diagnose or treat disease, nor do her services replace the necessary services of a licensed physician.
2. Brenda Bennett makes no representations, claims, or guarantees regarding the efficacy of her recommendations. The recommendations are based upon a combination of her nutrition and health coaching education and knowledge of natural health literature.
3. I understand that the nature of the recommended treatments for my care will be explained to me and that I will have the opportunity to ask questions of those involved in my care. I am not being forced to accept treatment.
4. Individualized recommendations are offered and applied as an educational and informative consultation. Any action taken as a result of the consultation is done at the sole discretion and risk of Client. Therefore, it is strongly recommended that in addition to any health consultation that you maintain a relationship with one or more physicians qualified to care for health condition(s). For example, in the case of children you are advised to seek the advice of a pediatrician; if you have cardiovascular disease, consult with a cardiologist; and if you have cancer, consult with an oncologist, etc.
5. Accepting this agreement by checking the box verifies that Client has not been told to discontinue treatments with any other medical specialists or other health care providers. This agreement is being accepted prior to rendering any service, advice, and/or recommendations whatsoever.
6. Financial Policy: Patients are fully responsible for all professional services received. Client is not contracted with insurance companies and does not bill for services. By accepting this agreement I confirm that I understand that I am responsible for all charges.
By checking the box, you agree to comply with the above polices and acknowledge that you understand all terms, verbiage (language) and concepts herein. Furthermore, Client agrees not to hold Brenda Bennett liable for any costs or damages related to the services provided other than for willful misconduct or gross negligence.
I understand this consent agreement and have executed it freely and willingly.
By checking the box I acknowledge that I have read and understand the contents of this liability agreement.
1. Brenda Bennett is a nutrition consultant and does not function as a physician, diagnose or treat disease, nor do her services replace the necessary services of a licensed physician.
2. Brenda Bennett makes no representations, claims, or guarantees regarding the efficacy of her recommendations. The recommendations are based upon a combination of her nutrition and health coaching education and knowledge of natural health literature.
3. I understand that the nature of the recommended treatments for my care will be explained to me and that I will have the opportunity to ask questions of those involved in my care. I am not being forced to accept treatment.
4. Individualized recommendations are offered and applied as an educational and informative consultation. Any action taken as a result of the consultation is done at the sole discretion and risk of Client. Therefore, it is strongly recommended that in addition to any health consultation that you maintain a relationship with one or more physicians qualified to care for health condition(s). For example, in the case of children you are advised to seek the advice of a pediatrician; if you have cardiovascular disease, consult with a cardiologist; and if you have cancer, consult with an oncologist, etc.
5. Accepting this agreement by checking the box verifies that Client has not been told to discontinue treatments with any other medical specialists or other health care providers. This agreement is being accepted prior to rendering any service, advice, and/or recommendations whatsoever.
6. Financial Policy: Patients are fully responsible for all professional services received. Client is not contracted with insurance companies and does not bill for services. By accepting this agreement I confirm that I understand that I am responsible for all charges.
By checking the box, you agree to comply with the above polices and acknowledge that you understand all terms, verbiage (language) and concepts herein. Furthermore, Client agrees not to hold Brenda Bennett liable for any costs or damages related to the services provided other than for willful misconduct or gross negligence.
I understand this consent agreement and have executed it freely and willingly.
I agree
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