Dr. Alim
PERMISSION & AUTHORIZATION FORM REGARDING THE USE OF AUTONOMIC RESPONSE TESTING
PLEASE READ BEFORE SIGNING:
I specifically authorize the natural health associates to perform whether in-person or remotely an Autonomic Response Test health analysis and to develop a natural, complementary health improvement program for me which may include dietary guidelines, nutritional supplements, etc. in order to assist me in improving my health, and not for the treatment or “cure” of any disease.
I understand that Autonomic Response Testing (ART) is a safe, non-invasive, natural method of analyzing the body’s physical and nutritional needs, and that deficiencies or imbalances in these areas could cause or contribute to various health problems.
I understand that Autonomic Response Testing is not a method for diagnosing or testing of any disease including conditions of cancer, AIDS, infections, or other medical conditions and that these are not being tested for and treated.
No promise or guarantee has been made regarding the results of the Autonomic Response Test or any natural health, nutritional or dietary programs recommended, but rather I understand that Autonomic Response Testing is a means by which the body’s natural reflexes can be used as an aid to determining possible nutritional imbalances, so that safe natural programs can be developed for the purpose of bringing about a more optimum state of health.
By signing this form, I attest that I (1) have personally read this form (or had it explained to me) and fully understand and agree to its contents; (2) have had my questions answered to my satisfaction, and the limitations, benefits, and alternatives shared with me in a language I understand; and (3) that this consent will remain active until I revoke it in writing (4) am providing informed consent to the services listed above .