Nutritional Consultation Agreement

I,___________________________________________________ am consulting  Gail Dothard to learn about natural, holistic ways of healthful living.

I understand that Gail Dothard is a Clinical Nutrition & Holistic Health Consultant and that She is not a medical doctor and does not diagnose, treat, prevent or mitigate medical diseases, conditions or injuries.

  I understand that nutritional and other holistic health modalities are not meant to substitute for medical diagnosis and treatment; and, that Gail Dothard recommends that their use be limited to helping me optimize my natural biological processes and cosmetic appearance.

I understand that Gail Dothard recommends that I discuss the content of this and any future consultation with my medical doctor, and that I consult my medical doctor before using any health foods, nutritional supplements or other health promoting products or diets; and, before starting any exercise or weight-loss programs.  I understand that if I do not have a medical doctor, Gail Dothard will be happy to refer me to one.

 I understand that clients are under no obligation to purchase nutritional supplements from Gail Dothard and that similar products may be found in health food stores.  I also understand that any nutritional or other product recommendations are not intended for the cure, alleviation, mitigation, treatment or prevention of any medical condition.

 I hereby grant a Private License to Gail Dothard to engage in nutritional and holistic health modalities with me.  I hereby release Gail Dothard from all claims and liabilities arising from the use or misuse of nutritional or holistic health modalities, indemnifying and holding her harmless from all claims and liabilities there from, whatsoever.  Gail Dothard reserves all rights.

 I certify that I am 18 years of age or older: ___Yes  ___No

I certify that I am not pregnant at this time: ___Yes  ___No

I certify that I have read Client’s Signature: _________________________________ Date: __________

 Address: ____________________________ City/State: ________________Zip:_____

Home Phone: ________________________ Business Phone: ____________________

and fully understand the above: __Yes  ___No 

Please complete agreement sign and date and return to: gail@hnwgail.com