Online Disclaimer FormPlease enable JavaScript in your browser to complete this form.DISCLAIMER AND INFORMED CONSENT AGREEMENT For Homeopathic Broadcasting Frequency Services Client Full Name: *Date of Birth: *Phone *Email *1. Nature of Services I understand that the services provided by About Your Health, LLC involve the remote or inperson transmission of homeopathic frequencies via a frequency device. I understand that this service is offered as an alternative wellness modality intended to support general well-being and energetic balance. I understand that this service is not a substitute for licensed medical care, diagnosis, or treatment by a licensed medical provider. No medical claims are made. 2. Voluntary Participation and Consent I confirm that I am receiving this service voluntarily for me and or my pet. I understand the general nature of frequency-based homeopathic services and consent to the administration of such services. I have had the opportunity to ask questions about the services offered and understand the scope and limitations of this modality. 3. Assumption of Risk and Release of Liability I understand that alternative wellness practices, including frequency-based homeopathy, may be considered unproven by conventional medical standards. I voluntarily assume any and all risks associated with receiving these services for me and or my pet. I hereby release, waive, discharge, and hold harmless the practitioner, their agents, business entity, heirs, and assigns from any and all claims, demands, liabilities, damages, or causes of action arising out of or connected to the services rendered, whether known or unknown, foreseeable or unforeseeable. This release extends to all claims of alleged negligence, malfunction, or misapplication of the frequency equipment, or misinterpretation of client information. 4. No Guarantees I understand that no guarantees or warranties have been made to me as to results or outcomes of any services rendered. 5. Confidentiality Any personal or health-related information I provide will be kept confidential and used solely for the purpose of administering services, unless otherwise required by law. 6. Legal Capacity I affirm that I am of sound mind and legal age (18 or older), or that I am the legal guardian of the minor receiving services. Client Signature * Birth: Client Client Date *Submit