Health Consultation Form Please purchase Health consultation in the store before filling out this form Please use the same email you used to purchase in the store Name Email Message What health symptoms are you experiencing I understand that this consultation and any assessment or information ensuing therefrom is for general educational purposes only and that no claim to medical diagnosis or treatment, or the cure of any medical condition, is inferred or implied. I further understand that this consultation and any recommendations ensuing therefrom should not be construed as a substitute for medical examination, diagnosis and treatment, licensed primary health care provider for any physical or mental ailment or complaint that I may have. I understand that an Holistic Health consultation may include assessment of conditions and related recommendations for dietary, herbal or other lifestyle regimens and that these are given from a Holistic Health perspective only. I understand that any suggestions or recommendations are in no fashion intended as a prescription for any condition. I understand that Holistic Health consultants are not qualified or licensed to diagnose, prescribe for or treat any physical or mental illness, and that nothing said in the course of any consultation should be construed as such. I understand that any healing process requires my active participation and is my own personal responsibility. Send
