Agreement of Responsibility and Informed Consent:

  • Date Format: MM slash DD slash YYYY
  • 1. That I am here, on this and any subsequent visit, solely on my own behalf and not as an agent for any federal, provincial, municipal or professional agency on a mission of entrapment or investigation. 2. Jenna Gallagher is not a physician or psychologist, and the scope of her consultation services does not include treatment or diagnosis of specific illnesses or disorders. If you, the client, suspect you may have an ailment or illness that may require medical attention, then you are encouraged to consult with a licensed physician without delay. Only a licensed physician can prescribe drugs. Any mention of drugs in the course of consultation is only for the purpose of providing a complete history of drugs that the client is taking and not for Jenna Gallagher to judge the appropriateness of the medication. Any change in prescription or dosage is a decision the client makes with his or her physician. Jenna Gallagher will not be held liable for failure to diagnose or treat an illness, nor will she be liable for failure to prevent future illness. 3. The services provided by Jenna Gallagher are at all times restricted to consultation on the subject of natural health and well being and to helping me gain a better understanding of my level of health so that I will have a greater self-awareness and be able to use a self-care program. These services do not involve the diagnosing, prognosticating, treatment, or prescribing of remedies for the treatment of any disease, or any licensed or controlled act which may constitute the practice of medicine in Ontario. 4. I understand that the recommendations, discussion, sale of nutritional supplements or essential oils pertain to the “whole body” energetic concept of nutrition and do not relate in the context of any specific ailment or condition. 5. While people generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and diet, Jenna Gallagher does not promise or guarantee protection from future illness. 6. Additionally, you promise to give Jenna Gallagher a complete and accurate account of any medical conditions that you may have and any medications that you are taking. 7. The Programs that are provided are property of Now-Wellness and Jenna Gallagher, it is not to be shared, sold, replicated of any kind, under any circumstances. 8.This agreement is being signed voluntarily and not under duress of any kind. 9.. If under the age of 18, the parent/guardian is acknowledging the above for the client.