I hereby acknowledge and agree:

 

1. The purpose of nutritional counselling is to improve the overall health, vitality and well-being of the body through nutritional education and the use of natural foods and non-medicinal nutritional supplements. The Nutritional Therapist, Mrs Cathy Young, does not diagnose diseases, disorders or conditions.

 

2. The Nutritional Therapist, Mrs Cathy Young, is a registered Naturopath with the Association of Naturopathic Practitioners (ANP).

 

3. As part of the Nutritional Counselling Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. This information is collected to enable the Nutritional Therapistto: (i) assess my knowledge of nutrition, (ii) education me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality and overall

well-being. The Nutritional Therapist, Mrs Cathy Young will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.

 

4. If the Nutritional Therapist, Mrs Cathy Young,suspects the existence of disease, disorder or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Physician or Naturopath about any suspected problems.

 

5. Should I request the Nutritional Therapist, Mrs Cathy Young, to recommend dietary changes and/or nutritional supplements to enhance my body’s natural ability to resist and/or overcome a known disease, disorder or condition, it is my responsibility to disclose the nature of the disease, disorder or condition and all other relevant details to the Nutritional Therapist, Mrs Cathy Young. If I have not previously consulted a licensed Physician or Naturopath about this disease, disorder or condition, I acknowledge that I am directed to promptly do so. I am not to alter or discontinue treatments prescribed by a licensed Naturopath, Physician or other licensed health professional without consulting the individual who prescribed the treatment.

 

6. In providing Nutrition Counselling Services to me, the Nutritional Therapist, Mrs Cathy Young, is relying upon the truth, accuracy and completeness of all information I have provided to her. Any recommendations I follow for changes in diet, including the use of nutritional supplements, are entirely my responsibility.

 

7. Mrs Cathy Young is in no way liable for my health or safety.

 

8. In consideration of my participation in the Nutritional therapy and root cause treatment services, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release the Nutritional Therapist, Mrs Cathy Young, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in the Nutritional therapy and root cause treatment services, whether caused by negligence or otherwise.

 

9. 24 hours noticeis required for cancelling appointments. Appointments cancelled within 24 hours of your appointment time, you will be billed.

 

10. I understand that any therapies I undertake with Cathy Young are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Cathy Young is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated

 

Introduction 

It is common practice for naturopaths, nutritionists, and other non-licensed practitioners to collect your signature on a form such as this. By doing so you acknowledge and accept that I:

• Am not medically trained
• Am not a substitute for advice from a qualified doctor;
• Recommend that you speak to your doctor before making any dietary changes or changes to your exercise regime or taking any dietary supplements;
• Do not warrant the accuracy of any information provided;
• Am not liable for any losses you may suffer by relying on our advice;
• Do not recommend any particular product;
• Am not a covered entity or a business associate of a covered entity.

By your signature below, and/or by instructing us to provide advice and services to you, you indicate your agreement to these terms.

 

What I do and do not do 

I obtain a set of laboratory test results and provide you with a nutritional interpretation of those test results that you can use exclusively as an educational tool for personal health purposes.

Your doctor may use the same test results to diagnose and treat disease, but I do not do this. The information I provide is not intended to, cannot, and should not be expected to be a substitute for a personal consultation with your own qualified doctor. I do not accept any liability for any failure to identify any medical condition or disease; this is not the purpose of my services.

I may provide you with information relating to products that I believe might benefit you, but such information is not to be taken as an endorsement or recommendation. Some such products may not be available without a prescription, but I do not dispense or prescribe any prescription products. The information provided is intended for educational purposes only and should not be taken as professional medical advice or used as a substitute for medical care. I am not responsible for any adverse effects or consequences that may result, either directly or indirectly, from that information.

I will make reasonable effort to protect the privacy of your medical information that is shared with me, including any medical test results. However, that information is not protected by doctor-patient confidentiality.

 

Consult your doctor 

I am not a qualified medical advisor and make no claims to be so. The information I provide should not be taken to be, and is not a substitute for, personal medical advice and instruction. You should not take any action based solely on my advice.

You should consult your doctor:

 

• for any medical interpretation of your test results;
• on any matter relating to your health and ill-being;
• before making any changes o your exercise or diet;
• before taking any nutritional, herbal, homeopathic of hormonal supplementation.
• before beginning any therapy.

 

Exclusion of warranties

I will provide my services to you with reasonable care and skill. But I make no other warranty, express or implied, with respect to those services. All other warranties are excluded to the maximum extent permitted by law.

I make no warranty as to the accuracy of the laboratory test results, I receive.

I make no warranty, expressed or implied, as to the quality or effectiveness of any diagnosis, apparatus, treatment, or product. In no event will I be liable for any physical or mental injury, or any negative side effects, that may arise from the use of any such diagnosis, apparatus, treatment or product.

I believe that the information I provide, including that on my websites, brochures, flyers and information packets, is accurate, but I cannot guarantee such accuracy. I therefore make no warranty as to the accuracy of that information, and it should not be relied upon as being correct, complete or accurate. It is your responsibility to verify such matters independently from primary sources of information and by taking specific professional advice.

 

Exclusion of liability 

If you rely on, buy or use a product or therapy, you do so at your own risk. Each person is different, and the way someone reacts to a product or therapy may be significantly different from another. I cannot predict how you may react to any particular product or therapy.

To the maximum extent permitted by law, I exclude:

 

• any and all liability in contract, tort (including negligence), breach of statutory duty or otherwise for any direct, indirect, special, incidental, or consequential costs, losses, claims, damages, expenses or proceedings (including but not limited to loss of profits and wasted management time) incurred or suffered by you arising directly or indirectly out of or in connection with my services, including but not limited to any loss, damage or expense arising from any defect, error, imperfection, fault, mistake or inaccuracy with the information or advice I provide;
• any and all liability for injury or loss arising out of the use of, or reliance on, the laboratory results and/or the dietary, supplement and lifestyle suggestions I may provide;
• any and all liability for injury or loss arising from any product or treatment you may choose to take;
• any and all liability for any failure to identify any medical condition or disease. You understand and agree that this is not the purpose of our services.

This is a comprehensive limitation of liability that applies to all damages of any kind, including (without limitation) compensatory, direct, indirect or consequential damages, loss of data, income or profit, loss of or damage to property and claims of third parties.

 

No recommendation 

All material and information I may provide about products and therapies is provided solely for educational purposes and for use when discussing your health with your doctor. By providing you with such material and information, I do not necessarily endorse, recommend or promote any such product or therapy.

Entering/typing name in the signature field below constitutes signing the document, confirming the signer agrees to the terms and conditions stated in this document.

 

Refund policy

Given the nature of the downloadable items you receive as soon as you join the programme and the payment made immediately to labs, no refunds will be given if you change your mind.

 

Payment plans

All payments plans must be completed in full. Payments plans cannot be cancelled, even if you decide to not finish any treatment plans or programmes.  By choosing a payment plan, it is to help you spread the cost of the programme - not a ‘try before you buy’ service.

 

 

 

 

 

 

 

 

 

 

 

Assumption of Risk and Release of Liability

I hereby acknowledge and agree:

 

1.     The purpose of nutritional counselling is to improve the overall health, vitality and well-being of the body through nutritional education and the use of natural foods and non-medicinal nutritional supplements. The Nutritional Therapist, Mrs Cathy Young, does not diagnose diseases, disorders or conditions.

 

2.     The Nutritional Therapist, Mrs Cathy Young, is not a licensed Dietitian, Naturopathic Doctor or Medical Physician.

 

3. As part of the Nutritional Counselling Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. This information is collected to enable the Nutritional Therapist to: (i) assess my knowledge of nutrition, (ii) education me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality and overall

well-being. The Nutritional Therapist, Mrs Cathy Young will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.

 

4.     If the Nutritional Therapist, Mrs Cathy Young ,suspects the existence of disease, disorder or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Physician or Naturopath about any suspected problems.

 

5.     Should I request the Nutritional Therapist, Mrs Cathy Young, to recommend dietary changes and/or nutritional supplements to enhance my body’s natural ability to resist and/or overcome a known disease, disorder or condition, it is my responsibility to disclose the nature of the disease, disorder or condition and all other relevant details to the Nutritional Therapist, Mrs Cathy Young. If I have not previously consulted a licensed Physician or Naturopath about this disease, disorder or condition, I acknowledge that I am directed to promptly do so. I am not to alter or discontinue treatments prescribed by a licensed Naturopath, Physician or other licensed health professional without consulting the individual who prescribed the treatment.

 

6.     In providing Nutrition Counselling Services to me, the Nutritional Therapist, Mrs Cathy Young, is relying upon the truth, accuracy and completeness of all information I have provided to her. Any recommendations I follow for changes in diet, including the use of nutritional supplements, are entirely my responsibility.

 

7.     Mrs Cathy Young is in no way liable for my health or safety.

 

8.     In consideration of my participation in the Nutritional therapy and root cause treatment, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release the Nutritional Therapist, Mrs Cathy Young, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in the Nutritional therapy and root cause whether caused by negligence or otherwise.

 

9.     24 hours notice is required for cancelling appointments. Appointments cancelled within 24 hours of your appointment time, you will be billed.

 

10.     I understand that any therapies I undertake with Cathy Young are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Cathy Young here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.

Client Signature

I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO THE TERMS OUTLINED ABOVE. I UNDERSTAND THIS AGREEMENT TO BE A FULL AND FINAL RELEASE OF ALL COSTS, CLAIMS, CAUSES OF ACTION AND DAMAGES OF ANY KIND ARISING FROM OR IN CONNECTION WITH THE NUTRITION COUNSELLING SERVICES.