The privacy of your medical information, as described in the HIPPA Privacy Act, is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us at the address provided at the end of this notice. We may use medical information about you to doctors, nurses, technicians, medical students or other health care providers to assist them in treating you. We may use and disclose your medical information for payment purposes. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include your medical information.
Holistic Hair Rejuvenation
I am solely responsible for the decision to consult with Myeesha Sanders, Certified Hair Loss Practioner, Plentiful Hair Studio LLC DBA Holistic Hair Rejuvenation. I recognize that some recommendations may not prove to be successful. I understand some recommendations may be novel. I agree to participate in an active manner, monitor my progress, and report any concerns to Myeesha Sanders, Certified Hair Loss Practioner, Plentiful Hair Studio LLC. ,or her staff. I also understand that any significant symptoms should be reported to a medical professional. It is also recommended that I discuss the use of any nutritional supplements with my doctor before implementing.
Our services and research programs DO NOT diagnose or prescribe for disease conditions. All clients are encouraged to seek competent medical help when those services are deemed necessary. A client accepts total responsibility for his/her own health care and maintenance.
Nothing said, done, or performed, typed, printed, or produced by Plentiful Hair Studio LLC DBA Holistic Hair Rejuvenation and acting staff/personnel is intended or meant to diagnose prescribe, treat a disease or take the place of a licensed physician. Our educational research program can include evaluation of hair/mineral analysis, accessing harmful lifestyles and habits, cultivation of positive mental attitudes, nutritional recommendations, and supporting belief systems. All these modalities are designed solely to enhance physical fitness, mental attitude/alertness, good nutrition and an appreciation of the environment.
We DO NOT diagnose or make any claims to cure any disease condition. We make no claims or imply any claims that suggest cures for any conditions. Furthermore, we do not claim any supplemental material we may suggest will cure any condition or its purpose is to treat any condition. In essence, we do not prescribe for or treat any disease(s)
Nutritional research assessment and suggestions are intended only for the support and maintenance of achieving optimal health and does not involve diagnosing, prognosticating (foretelling), or prescribing of food supplements or remedies for the treatment of disease conditions.
A variety of non-invasive research methods, modalities, and programs may be used which can include enzyme research, pH testing (saliva), urine testing, blood type testing, blood lab review, HMA testing, Bio-kinesiology (muscle response testing), Iridology to name a few.
I have read and understand all the above. I understand Plentiful Hair Studio LLC nor staff/personnel/office affiliates make no claims to be licensed medical professionals. I agree and therefore consent to participate in further assessment and evaluation with Plentiful Hair Studio LLC DBA Holistic Hair Rejuvenation.
Plentiful Hair Studio LLC does recognize the suggested CDC, WHO, and State regulations can have adverse affects on the health of some individuals. With this in mind, if you currently follow Nature's L.A.W.S (take care of your health, eat right, exercise, rest, water, prayer, meditation, etc), we applaud you and encourage you to continuing doing so to boost and maintain a healthy state of mind and body.
I grant permission to Plentiful Hair Studio LLC DBA Holistic Hair Rejuvenation to use photographs, Zoom, Facebook Live and any other electronic captures of me. This can be used for including but not limited to publications such as newsletters, brochures, display boards and on the Plentiful Hair Studio and/or Holistic Hair Rejuvenation website.
I hereby waive any right to inspect or approve the finished images. I also waive the rights to royalties or compensation for the use of my images.
I attest that I am 18 years old or older and am competent to contract in my own name. I have read this release before signing and I fully understand its contents, meaning and impact of this release.