client agreement & release

1. I,
understand that Healthy Nest Nutrition, LLC (Healthy Nest Nutrition) will provide me with professional nutritional evaluation, therapy, and support for the purpose of enhancing my health (Nutrition Therapy).  I understand that Nutrition Therapy is not intended as a diagnosis, treatment, prescription or cure for any disease, mental or physical, and is not intended as a substitute for regular medical care. In Nutrition Therapy there are no medical procedures performed and medications are not prescribed.   

I understand that Nutrition Therapy services will be provided by Robin Hutchinson who is a Master Nutrition Therapist and has completed two years of schooling at The Nutrition Therapy Institute, an accredited Nutrition Therapy College.  I understand Robin Hutchinson is not a physician licensed pursuant to Article 36 of C.R.S. Title 12, nor licensed, certified, or registered by the State of Colorado as a health care professional and I should discuss any recommendations made by Healthy Nest Nutrition with my primary care physician, obstetrician, gynecologist, oncologist, cardiologist, pediatrician or other board-certified physician. 

I release Healthy Nest Nutrition from any liability for my health issues.   I have truthfully completed the Client Intake Form for Healthy Nest Nutrition and listed all my known physical and medical conditions, as well as any medications and supplements that I am taking and I will keep Healthy Nest Nutrition informed of any changes.  I agree to pay Healthy Nest Nutrition's rates, which are outlined in the attached fee schedule.  Healthy Nest Nutrition does not accept health care insurance.  Healthy Nest Nutrition is covered by liability insurance applicable to any injury caused by an act or omission by its provision of alternative health care services.   

This agreement and release is being signed voluntarily and not under duress of any kind.
2. name:
3. address:
4. city/state/zip
5. daytime phone:
6. email:
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8. date: