Updated Health Consultant Status Form

"I hereby agree and acknowledge that I have read and consent to the terms and conditions of this Health Consultant Status form and that by my submission of this form via the About Your Body website I shall abide by its terms and agreements as if I had signed this document and delivered it in person, prior to my first consultation. I further agree that I shall either mail or hand deliver the original signature page to About Your Body indicating my true and accurate signature."

I fully understand that the attending health consultant is not a medical doctor and is not a psychologist. I also understand that diagnosis or treatment for any disease or health condition is beyond the scope of any health consultant. If I have such health problems, disease or health condition, I am now being advised to seek qualified medical advice from a licensed physician.

I am here as a client on this or any subsequent visit, solely on my own behalf and not as an agent for federal, state, local or medical agencies for any investigative purposes, and I accept legal responsibility for any cost to the corporation of AYB Inc. or personal financial loss to Daniel Phend, due to lost wages, legal fees, damage to the office equipment and restoration of client files and data. I affirm the above statement and accept responsibility by signing this legally binding form.

I understand that ABOUT YOUR BODY INC. consultants teach clients how to build their health through training in the effective use of life-style modification pollution avoidance, clean air, pure water, proper foods, rest, exercise, goal orientation, positive mental attitudes, stress reduction, affecting overall health.

I realize that services provided mayor may not include examination of saliva, hair samples, urine, usual dietary practices, computerized analysis, for the purpose of stamina and stress evaluations. Any evaluation test is not medical in nature and such tests are not procedures for the purpose of diagnosis or treatment of any disease or health condition.

I fully understand that the attending health consultants do not offer allopatric drugs, surgery or chemical stimulants or chemo radiation therapy. I understand that illness is not being diagnosed or treated. Wellness is being measured and increased. If I desire any services not provided by the attending health consultant, which is my prerogative, I fully understand that I should seek them elsewhere.

I have solicited the attending health consultant services in good faith exercising my free will and following the dictates of my own conscience, which allows me to select what I understand is most beneficial to my health. Recommendations, suggestions, and references to meals, menus and nutritional supplements, herbal or homeopathic products are for body building, increased stamina and energy and general health maintenance and do not involve diagnosing, prognosticating or prescribing for the treatment of any disease or health condition.

I fully understand that the attending health consultant is encouraging me to maintain my current relationship with my attending physician and what he or she has directed.

If I am accompanied by a minor or incompetent, I give full faith that I am legally and totally responsible for the client. I presently seek counsel, advice, opinions, points of view and programs within the scope of practice of the attending health consultants wellness clinic. I am aware and release the health consultant to do analysis on me or the person referred to in the statement above.
I understand that the consultants named above are dedicated to educating clients to help themselves to better health, and I agree to accept the responsibility for my own health. I realize that natural health is not an exact science and has many variables. Results from lifestyle changes are not consistently predictable. I fully understand that it is my responsibility to arrange for alternate traditional procedures if I suspect any disease or health problem prior to or after any analysis, and by signing this form, I agree to accept this responsibility.
I give full affirmation that I have read and understand this document entirely and that I have received a verbal explanation of any portion that I have had any questions about by the attending health consultant, and he/she has adequately answered my questions and concerns.

I understand that the consultation or analysis is not covered by insurance.
I also understand that there are no refunds for returned products.
I affirm I am legally and financially responsible and if I am divorced, I am the custodial parent of this client.

1 am willing and prepared to declare, affirm or repeat under oath all of the above statements at the attending health consultants request.

Do not hit next on this form unless you completely understand the contents

If for any reason you do not wish to submit this form, consultation will not be rendered.