NeurOptimal® Client Consent Form
By signing this consent form, I acknowledge and confirm the following:
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I understand that NeurOptimal® is training and not a medical treatment, device or methodology. It is not used to diagnose medical disorders nor is it used as a medical treatment for disorders. The FDA has designated NeurOptimal® as a General Wellness Product, safe to be used directly by consumers without the need of a doctor or healthcare provider's prescription or oversight.
I understand that NeurOptimal® is a training tool and does not diagnose, treat, or cure any disease, disorder or abnormal physical state, nor does it restore, modify or correct the body’s structure or functioning. While Zengar users may or may not be licensed health care practitioners, their use of NeurOptimal® is solely as a tool for brain training and optimization and not as a means of diagnosis or as a medical intervention.
I understand that it is not possible to predict what my central nervous system will do with the information it is offered, and consequently there can be no guarantee as to the results of my training. I agree to cease training if I am less than happy with the results I am getting.
I understand NeurOptimal® is purely a source of information and does not direct the response of the central nervous system and agree to not hold Zengar Institute Inc, MindSpa901, LLC or any of its users and trainers responsible for a less than desired outcome or any outcome that may be considered negative.
I am satisfied with the information I have been provided (verbal, written, or otherwise) by my trainer on the effects I can expect during my NeurOptimal® training and my questions have been answered to my satisfaction.
I consent to have my photograph shared to social media for marketing campaigns or testimonials.
I have read this whole document and I accept the terms indicated above.
Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
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Format: (000) 000-0000.
Client's Signature
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Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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