INFORMED CONSENT STATEMENT
I fully understand that Katherine Elizabeth Smith is a lay natural health advisor who deals strictly in helping people to improve their general health and fitness through improved lifestyle, health habits, and herbal products.
I fully understand that Katherine Elizabeth Smith is not a licensed physician, and cannot diagnose diseases, prescribe drugs, or recommend treatments for specific disease conditions.
I understand that all evaluations performed Katherine Elizabeth Smith are for the sole purpose of helping me to improve my general health through lifestyle and habits. I further understand that said evaluations cannot determine specific disease conditions I may have, and do not replace the diagnostic services offered by licensed physicians.
I understand that Katherine Elizabeth Smith neither claims, nor implies, that any instruction, advice, counsel, suggestions, recommendations, services, or products she or her representatives provide, whether in person or by video, mail, email, or telephone, will cure, treat, prevent, or mitigate any disease condition, but are provided solely for supporting the natural function of body systems and improving general health and fitness.
I understand that Katherine Elizabeth Smith will not suggest that I cease any medical care I may be undertaking. I understand that the decisions I make regarding my health care and the health care of those under my guardianship are my responsibility and certify that I will not hold Katherine Elizabeth Smith responsible for the consequences of my decisions.
I understand that Katherine Elizabeth Smith believes that genuine healing comes only from the individual, and that simple and natural methods such as rest, herbs, healthy diet, exercise, and stress management help many people recover and maintain their health. I further understand that Katherine Elizabeth Smith shares these methods with others as part of her God-given and constitutional rights of freedom of speech.
I understand that my medical information will be held confidential by Katherine Elizabeth Smith. While she may consult with her mentor on my case, all identifying information will be kept confidential. I have read and understand the foregoing and agree to the terms and conditions set therein.
Today's Date:
Unless you are local to the area, this is where your custom herbal medicines will be shipped.
Example: Bloating, started in 2020, rate 8/10
cancer (include type), diabetes, heart disease, high blood pressure, thyroid disease, autoimmune disease, mental health issues, seizures, hepatitis, alcoholism, etc...
