I understand that SHAPE ReClaimed is a lifestyle modification, health restoration program designed to help me improve my overall health. This program is not intended to replace the guidance of my primary health care experts. While this program is not used to diagnose, treat, cure or prevent any disease, I understand any medications I am currently taking may need dose adjustment. I agree to notify my prescribing physician that I am working with Olivia Braglin and will be closely monitored while incorporating this program for embracing a healthier lifestyle. I understand an anti-inflammatory nutritional regimen will be recommended based on my unique health history, urine analysis and symptoms. Practitioner Statement of Intent: I, Olivia Braglin at Vibrant Wellness Center, understand that my intent and responsibility is to determine if SHAPE ReClaimed is a program that would be beneficial for assisting your body in its innate healing process. Our first appointment with you will be multi-faceted. We agree to do the following: take full health history, assess the client, discuss goals, perform baseline urine analysis, make client recommendations, determine client follow-up protocol and educate the client regarding living a healthy lifestyle. Client Acceptance of Responsibility: I have been informed and understand that nutritional and lifestyle recommendations may involve certain risks. These may include, but are not limited to detoxification symptoms, such as: initially feeling worse due to the release of stored toxins, digestive symptoms, fatigue, headaches, muscle and joint pain, allergic reactions or any unpredictable reaction with my prescribed medications that has not been found in research literature, etc. In addition, I agree to do the following: submit full health history, discuss goals, have consistent urine analysis and follow-up visits as recommended by SHAPE practitioner, read “The Complete Guidebook,” review the information provided under the “Education” tab on the SHAPE ReClaimed website (www.shapereclaimed.com), be aware that I can become a member of the “OFFICIAL SHAPE ReClaimed Support Group” on Facebook and will not substitute recommendations from Facebook for my specific health needs, understand that my SHAPE Practitioner can refuse sale of additional product if I have not followed the recommended protocol set up for my healing.
I have been informed and understand that nutritional and lifestyle recommendations may involve certain risks. These may include, but are not limited to detoxification symptoms, such as: initially feeling worse due to the release of stored toxins, digestive symptoms, fatigue, headaches, muscle and joint pain, allergic reactions or any unpredictable reaction with my prescribed medications that has not been found in research literature, etc.
In addition, I agree to do the following:
*Submit full health history
*Discuss goals
*Have consistent urine analysis and follow-up visits as recommended by SHAPE practitioner
*Read “The Complete Guidebook”
*Review the information provided under the “Education” tab on the SHAPE ReClaimed website (www.shapereclaimed.com)
*Be aware that I can become a member of the “OFFICIAL SHAPE ReClaimed Support Group” on Facebook and will not substitute recommendations from Facebook for my specific health needs.
*Understand that my SHAPE Practitioner can refuse sale of additional product if I have not followed the recommended protocol
