Assumption of Risk and Release of Liability

I HEREBY ACKNOWLEDGE AND AGREE:

  1. The purpose of nutritional counseling is to improve the overall health, vitality, and well-being of the body through nutritional education and the use of natural foods and non-medicinal nutritional supplements. The Certified Nutrition Specialist, Danielle Arnold, does not diagnose diseases, disorders, or conditions.

  2. The Certified Nutrition Specialist, Danielle Arnold, is not a licensed Dietitian, Naturopathic Doctor, or Medical Physician. She has a Master of Science degree in Nutrition & Integrative Health from the Maryland University of Integrative Health and is a Certified Nutrition Specialist (CNS) candidate.

  3. As part of The Source Functional Nutritional Counseling & Health Coaching Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle, and diet. This information is collected to enable the Certified Nutrition Specialist, Danielle Arnold to: (i) assess my knowledge of nutrition, (ii) educate me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality, and overall well-being. The Certified Nutrition Specialist, Danielle Arnold will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.

  4. If the Certified Nutrition Specialist, Danielle Arnold, suspects the existence of a disease, disorder, or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Physician or Naturopath about any suspected problems.

  5. Should I request the Certified Nutrition Specialist, Danielle Arnold, to recommend dietary changes and/or nutritional supplements to enhance my body’s natural ability to resist and/or overcome a known disease, disorder, or condition, it is my responsibility to disclose the nature of the disease, disorder or condition and all other relevant details to the Certified Nutrition Specialist, Danielle Arnold. If I have not previously consulted a licensed Physician or Naturopath about this disease, disorder, or condition, I acknowledge that I am directed to do so promptly. I am not to alter or discontinue treatments prescribed by a licensed Naturopath or Physician without consulting the individual who prescribed the treatment.

  6. In providing Nutrition Counseling Services to me, the Certified Nutrition Specialist, Danielle Arnold, relies on the truth, accuracy, and completeness of all information I have provided her. Any recommendations I follow for changes in diet, including the use of nutritional supplements, are entirely my responsibility.

  7. Certified Nutrition Specialist, Danielle Arnold is in no way liable for my health or safety.

  8. In consideration of my participation in The Source Functional Nutritional Counseling & Health Coaching Services, I hereby accept all risks to my health, including injury or death that may result from such participation and I hereby release the Certified Nutrition Specialist, Danielle Arnold, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in The Source Functional Nutritional Counseling & Health Coaching Services, whether caused by negligence or otherwise.

  9. Twenty-four hours is required for canceling appointments. Appointments canceled within 24 hours of your appointment time, you will be billed at 50%.

  10. I understand that any therapies I undertake with Certified Nutrition Specialist Danielle Arnold are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Certified Nutrition Specialist Danielle Arnold is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice and in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim, or damage whatsoever, known or unknown, incurred as a result of same, and I, my heirs, executors, administrators, or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, fully understand its contents, and voluntarily agree to the terms and conditions stated.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTOOD IT TO BE A FULL AND FINAL RELEASE OF ALL COSTS, CLAIMS, CAUSES OF ACTION, AND DAMAGES OF ANY KIND ARISING FROM OR IN CONNECTION WITH THE SOURCE FUNCTIONAL NUTRITION COUNSELING & HEALTH COACHING SERVICES.