W4771 Gatewood Heights Rd., Tomahawk, WI 54487
PERMISSION & AUTHORIZATION FORM REGARDING THE USE OF NUTRITION RESPONSE TESTING™ and BioIntegrative Health Assessment
PLEASE READ BEFORE SIGNING:
I specifically authorize the natural health practitioners at Organique to perform a Nutrition Response Testing and BioIntegrative Health Assessment to develop a natural, complementary health improvement program for me which may include dietary guidelines, nutritional supplements, lifestyle adjustments, and so forth. In order to assist me in improving my health, and not for the treatment or "cure" of any disease.
I understand that Nutrition Response Testing and BioIntegrative Health Assessments are safe, non-invasive, natural methods of analyzing the body's physical and nutritional needs and imbalance in these areas could cause or contribute to various health problems.
I understand that Nutrition Response Testing and BioIntegrative Health Assessment is not a method for "diagnosing" or "treating" of any disease including conditions of cancer, AIDS, infections or other medical conditions, and that these are not being tested for or treated.
No promise or guarantee has been made regarding the results of Nutrition Response Testing, BioIntegrative Health Assessment, or any natural health, nutritional or dietary programs recommended, but rather I understand that these methods are a means by which the body's natural reflexes and components can be used as an aid to determining possible nutritional imbalances, so that safe natural programs can be developed for the purpose of bringing about a more optimum state of health.
I have read and understand the foregoing.
This permission form applies to subsequent visits and consultations.