Informed consent form

I, ________________________________________, hereby attest and agree to the following:

I fully understand that Janice Myers is a lay natural health advisor and teacher who deals strictly in helping people to improve their general health and fitness through better nutrition, improved lifestyle and health habits, and positive mental attitudes.

I fully understand that Janice Myers is not a licensed physician and cannot diagnose diseases, prescribe drugs or recommend treatments for specific disease conditions.

I understand that all evaluations performed by Janice Myers or her representatives are designed to evaluate my inherent constitution and temperament for the sole purpose of helping me to improve my general health through nutrition, habits, and attitudes. I understand that said evaluations cannot determine specific disease conditions I may have. These evaluations do not replace the diagnostic services offered by licensed physicians.

I understand that Janice Myers neither claims nor implies that any instruction, advice, counsel, suggestions, recommendations, services or products she or her representatives provide, whether in person, by mail or telephone, will cure, treat, prevent, or mitigate any disease condition: but are provided solely for the purpose of increasing energy, supporting the natural function of body systems, and otherwise improving general health and fitness.

I certify that Janice Myers, or her representatives, has not suggested that I cease any medical care I may currently be undertaking. I understand that the decisions I make regarding my health care and the health care of those under my guardianship are my responsibility. I certify that I will not hold Janice Myers, or her representatives, responsible for the consequences of my decisions.

I certify that I am here on this visit, and on any subsequent visit or contact, whether by mail, telephone, or in person, solely on my own behalf and not as an agent or representative of any federal, state, county, or local government or private agency on a mission of investigation.

I have read and understand the foregoing and agree to the terms and conditions set therein.

Dated this ________ day of _________________, 20 __________

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Client / Guardian Signature