| CONTRACT OF
AUTHORIZATION IN THE HOMEOPATHIC & NUTRITIONAL HEALTH ANALYSIS PROCEDURE
FOR ENERGY EVALUATION PLEASE READ CAREFULLY BEFORE
SIGNING:
I understand and acknowledge that Anthony Reinglas is
NOT a Medical Doctor, Psychiatrist, or any other kind of Doctor of
Medicine, nor does he hold herself out as one. I also understand and
acknowledge that Anthony Reinglas is a Practitioner of Homeopathy and
Naturopathy.
I hereby authorize Anthony Reinglas, and
his representatives to act on my behalf concerning Homeopathic and
Nutritional Health Analysis
Procedure for Energy Evaluation. I specifically authorize him to perform a
Homeopathic and Nutritional Health Analysis Procedure for Energy
Evaluation and develop for me a suggested Nutritional and Homeopathic
Health Program.
I warrant that all information submitted for analysis
and evaluation was submitted by me and is true to the best of my
knowledge.
I recognize that the Homeopathic and Nutritional Health
Analysis Procedure is an established method that is not yet approved by
the medical profession, or the Food and Drug Administration, although it
has not been rejected.
I acknowledge that the Homeopathic and Nutritional
Health Analysis Procedure, the Evaluation, the Research on the Zizia
program, the Hair Analysis and the suggested Nutritional Health Program
are not for diagnosis, treatment, care, alleviation, mitigation,
prevention, or care of any disease of any kind, in any way. However, I
reserve the right to use the knowledge I gain in the care of my own body
in any legal manner I may choose, including the suggested Homeopathic and
Nutritional Health Program.
I understand that although I have been requested to give
all of my symptoms, they are for research purposes to find in the Zizia
program the historic use of those Homeopathic remedies that match those
same symptoms, and are not meant to be used to diagnose or treat any
disease or condition of any kind.
I hereby attest and affirm that I am here as a
client/student, on this and any subsequent visit, solely on my own behalf.
By signing I accept and understand this waiver
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