I fully understand that this office is not a medical establishment and I am not here for a medical diagnosis. I understand that the practitioner I am about to see is a specialist in alternative therapies and wholistic practices, not a medical doctor. I hereby give all liberty and permission to this office and any of its staff to make all suggestions to my illness or described symptoms. I understand this office may utilize prayer, kinesiology, muscle testing, iridology, lab testing or other methods for evaluating. One or more alternative therapies may be used or suggested in order for me to reach vibrant health. All suggestions are in the best interest of my health. If I have any questions, I will ask them during my consultation. I agree to and will inform my practitioner prior to my session of any changes in my medications and health issues.

I understand that this office requires a 24 hour minimum advance notice of cancellation of a scheduled appointment and that cancellations made less than 24 hours before the appointment will be charged the regular fee. Due to the scheduling of other clients, this office cannot guarantee appointments for late arrivals, nor can they extend the allotted appointment time to accommodate a late arrival. I understand that my appointment will be automatically canceled 20 minutes after my scheduled appointment time and my credit card on file will be charged the regular fee.

I am not on this visit or any subsequent visit an agent for the federal, state, medical or local agencies or on a mission of entrapment or investigation.

Using, accepting or utilizing any of the nutritional information, suggestions or offered remedies or therapies is my own personal choice, for which I alone take full responsibility (which is my constitutional right).

I have read the listed contraindications for colon hydrotherapy and by my signature I testify I DO NOT HAVE ANY of those conditions. I am also aware that the use of colon hydrotherapy is by own personal choice and that the therapist is not a medical doctor nor portrays themselves as such. Colon hydrotherapy has not been clinically tested to provide ANY medical benefits. This facility does not claim that the use of colon hydrotherapy will cure or treat any condition or disease. This procedure is used solely for the purpose of evacuating the lower bowel.