Disclosure Statement and Consent for Treatment Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Individual *FirstLastIs the Individual below the age of 18years? *Minor (below 18years)AdultName of Parent or GuardianFirstLastConditions *I agree to the following termsHomeopathy is considered an alternative therapy and is not a substitute for medical treatment. The information and therapy offered does not include a diagnosis. Homeopathic remedies are available over the counter (OTC) and have been FDA approved. I, do hereby accept full responsibility for any actions taken by myself or my child concerning any homeopathic remedies, foods, herbs, supplements, exercises and educational therapies suggested by Rakhi Singh. I hereby release the aforementioned from any liability resulting in any possible damages or loss during our association. I understand that rather than medical advice or treatment, I am seeking alternative therapy in the form of lifestyle, educational, nutritional and homeopathic advice and/or recommendation. Under no circumstances, should any suggestions be taken as a diagnosis or direction against a licensed physical or mental health care professional. I affirm that I am seeking self-help advice in natural health or educational matters only, and if I desire a diagnosis or treatment for any medical condition, I must consult a physician. Date of Agreement *Submit