I , hereby attest and agree to the following:
1. I understand that PRACTITIONER Joanna Mann is participating in a mentorship program to enhance her/his clinical herbalist skills toward professional registration with the American Herbalists Guild and will review consultation cases with her mentor, who is a professional member of the American Herbalists Guild. In order to prove that she has met requirements for clinical hours, PRACTITIONER Joanna Mann will keep a separate list of client names and contact information, along with dates when she/he met with each client for consultation or follow-up appointments. This record will be submitted to the American Herbalists Guild (AHG) as part of her professional application. There will be no information concerning the nature or details of the wellness consultation included in this record. Some clients may be contacted by the AHG to verify that the consultation did indeed take place. During this contact, the AHG representative will not ask any questions about the nature of the consultation.
2. I am aware that PRACTITIONER Joanna Mann's training and education includes a two year program at the Appalachian Center for Natural Health as well as five years of experience in medicine making and running of Walden Farmacy.
3. I understand that the services provided by PRACTITIONER Joanna Mann are restricted to consultation and education and are intended to provide me with information to promote wellbeing. I understand that all evaluations performed by Joanna Mann 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 further understand that said evaluations cannot determine specific disease conditions I may have, and do not replace the diagnostic services offered by licensed physicians.
4. I fully understand that Joanna Mann 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, health habits, and positive mental attitudes.
5. I understand that the information I receive from PRACTITIONER Joanna Mann is not intended to diagnose, treat, or cure any disease or condition. I fully understand that Joanna Mann is NOT a licensed physician, and cannot diagnose diseases, prescribe drugs, or recommend treatments for specific disease conditions. I understand that Joanna Mann neither claims, nor implies, that any instruction, advice, counsel, suggestions, recommendations, services, or products she or her representatives provide, whether in person or by mail or by 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.
6. I understand that it is my constitutional right to decide how I wish to care for my health. PRACTITIONER Joanna Mann has not suggested that I cease any current medical care or therapies. I have sought PRACTITIONER Joanna Mann's advice and I recognize that I am free to act upon her recommendations as I see fit, and, as such, release her of all responsibility for my actions and any consequences thereof, both now and in the future. I understand that Joanna Mann or her representatives will not suggest that I cease any medical care I may 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 and certify that I will not hold Joanna Mann or her representatives responsible for the consequences of my decisions.
7. I understand that Joanna Mann believes that genuine healing comes only from Higher power, and that Higher intelligence has provided simple and natural methods such as rest, nutrition, herbs, exercise, attitude changes, and touch to help people recover and maintain their health. I further understand that Joanna Mann shares these methods with others as part of her Higher power-given and constitutional rights of freedom of speech and freedom of religion.
8. I am here on this and subsequent visits solely on my own behalf and not as an agent of federal, state, or local government agencies for purposes of investigation or entrapment.
9. I understand that payment is due at the time that consultation services are rendered.
I have read and understand the foregoing and agree to the terms and conditions set therein.
I have received a copy of this agreement.
Dated