I hereby certify that all information about my health condition and nutrition are accurate and true with the best of my knowledge. I understand that I am responsible for consulting my physician or health care provider about this nutrition consultation. These services do not attempt to treat, dignose, or cure disease. I release this institution and its employees from any liabilities,claims, and demands that may arise during this consultation. Each individual’s success depends on many factors, including his or her background, dedication, desire and motivation. By checking “I agree to these terms” and submitting this form where indicated below, you acknowledge that as with any life endeavor, there is inherent risk. There can be no guarantee of your results due to participation in the Program. By checking “I agree to these terms” and submitting this form where indicated below, you also acknowledge that you will pay in full for the services rendered.