Acknowledgment and Waiver of Liability
I accept and hereby certify and agree as follows:
I accept full responsibility for my health and voluntarily complete this Acknowledgment
and Waiver of Liability. I certify that I am seeking the consultation and treatment
services of Paul Dagesse or Barbara Dagesse or Dagesse CRA®/Wellness LIVE90 for
alternative healing suggestions and therapies, which I fully understand are NOT medical
diagnoses or substitutes for medical diagnoses or treatments. This practice specializes
in a natural approach to healing including, but not limited to, nutrition, consultation,
pharmaceutical suggestions, and energy healing. I certify that with respect to any
medical conditions or concerns I may have; I am advised to consult with my personal
care physician. I agree that if I am taking any prescription and/or psychiatric
medications while with Dagesse CRA®/Wellness LIVE90, I will not change
them without physician consent. With urgent questions, I will text and/or call the contact
information provided. In any given emergency, I understand that I need to call 911 or go
to the nearest emergency room. In accepting this waiver and becoming a client of
Dagesse CRA®/Wellness LIVE90, I understand I am seeking analyses and/or therapies
that may not be FDA registered or approved and may not be offered by
practicing physicians (allopathic or otherwise) and which may be considered
experimental. These include, but are not limited to Contact Reflex Analysis, Nutrition,
Nutraceuticals, Pharmaceuticals, Consulting, Hormone Balancing, Homeopathy,
Essential Oils, and Energy Balancing Techniques.
In addition, I agree that to remain an active client, I will pursue membership to gain the
benefits that are available with membership. I understand it is my responsibility to play
an active role in my wellness with Dagesse CRA®/Wellness LIVE90. I further agree that
if I choose to or NOT to participate in membership that my therapy is subject to my
personal responsibility. I further confirm that all communications Hi myself and Dagesse
CRA®/Wellness LIVE90 will be allowed through but not limited to, in face-to-face
communications, phone, text, and email. I understand that email or communications via
text are not 100 percent reliable, secure, or confidential.
I understand and agree that neither Paul Dagesse nor Barbara Dagesse nor Dagesse
CRA®/Wellness LIVE90 may make any claims whatsoever, expressed, or implied,
regarding effects or outcomes of the analyses or therapies provided and shall not be
liable for the same. I certify that I seek the advice and treatment of Paul Dagesse or
Barbara Dagesse or Dagesse CRA®/Wellness LIVE90 solely in my personal capacity,
and do not represent any governmental agency, law firm, attorney, or investigator. I am
not involved in a lawsuit nor am I gathering information for a potential lawsuit.
I understand and agree on behalf of myself, my dependents, heirs, administrators, legal
representatives, and assigns, to release and hold harmless Paul Dagesse or Barbara
Dagesse or Dagesse CRA®/Wellness LIVE90, and all associates, employees, agents,
and representatives thereof, from all liability for illness, injuries, or death, and for any
losses or damages relating thereto, however occurring, in relation to my consultation
with and/or treatment by Paul Dagesse or Barbara Dagesse or Dagesse
CRA®/Wellness LIVE90. Without limitation, I understand and agree that neither Paul
Dagesse nor Barbara Dagesse nor Dagesse CRA®/Wellness LIVE90, nor any
associates, employees, agents or representatives thereof, is liable for any direct,
indirect, consequential, or incidental damage, injury, death, loss, delay, or
inconvenience of any kind which may be occasioned by reason of any act or omission,
including, without limitation, any willful or negligent act or failure to act, or breach of
contract. My acceptance of this via e-contract signature indicates that I have carefully
read and reviewed this Acknowledgment and Waiver of Liability, and I fully understand
all its terms and conditions; I recognize and accept all risks and limitations involved in
seeking advice and treatment therapies from Paul Dagesse or Barbara Dagesse or
Dagesse CRA®/Wellness LIVE90 and associates, employees, agents and
representatives thereof; I have not relied upon any other promises, agreements, or
representations by Paul Dagesse or Barbara Dagesse or Dagesse CRA®/Wellness
LIVE90, or any associates, employees, agents or representatives thereof concerning
the treatment provided or the terms of this Acknowledgment and Waiver of Liability; I
have been encouraged by Paul Dagesse or Barbara Dagesse or Dagesse
CRA®/Wellness LIVE90 to seek the advice of legal counsel concerning this
Acknowledgment and Waiver of Liability; and I execute and deliver this
Acknowledgment and Waiver of Liability freely and voluntarily and without duress or
coercion and with full knowledge of the representations contained herein and the rights
relinquished, surrendered, released, and discharged hereunder. UNDERSTOOD,
ACCEPTED AND AGREED via e-contract.
I accept and hereby certify and agree as follows:
I accept full responsibility for my health and voluntarily complete this Acknowledgment
and Waiver of Liability. I certify that I am seeking the consultation and treatment
services of Paul Dagesse or Barbara Dagesse or Dagesse CRA®/Wellness LIVE90 for
alternative healing suggestions and therapies, which I fully understand are NOT medical
diagnoses or substitutes for medical diagnoses or treatments. This practice specializes
in a natural approach to healing including, but not limited to, nutrition, consultation,
pharmaceutical suggestions, and energy healing. I certify that with respect to any
medical conditions or concerns I may have; I am advised to consult with my personal
care physician. I agree that if I am taking any prescription and/or psychiatric
medications while with Dagesse CRA®/Wellness LIVE90, I will not change
them without physician consent. With urgent questions, I will text and/or call the contact
information provided. In any given emergency, I understand that I need to call 911 or go
to the nearest emergency room. In accepting this waiver and becoming a client of
Dagesse CRA®/Wellness LIVE90, I understand I am seeking analyses and/or therapies
that may not be FDA registered or approved and may not be offered by
practicing physicians (allopathic or otherwise) and which may be considered
experimental. These include, but are not limited to Contact Reflex Analysis, Nutrition,
Nutraceuticals, Pharmaceuticals, Consulting, Hormone Balancing, Homeopathy,
Essential Oils, and Energy Balancing Techniques.
In addition, I agree that to remain an active client, I will pursue membership to gain the
benefits that are available with membership. I understand it is my responsibility to play
an active role in my wellness with Dagesse CRA®/Wellness LIVE90. I further agree that
if I choose to or NOT to participate in membership that my therapy is subject to my
personal responsibility. I further confirm that all communications Hi myself and Dagesse
CRA®/Wellness LIVE90 will be allowed through but not limited to, in face-to-face
communications, phone, text, and email. I understand that email or communications via
text are not 100 percent reliable, secure, or confidential.
I understand and agree that neither Paul Dagesse nor Barbara Dagesse nor Dagesse
CRA®/Wellness LIVE90 may make any claims whatsoever, expressed, or implied,
regarding effects or outcomes of the analyses or therapies provided and shall not be
liable for the same. I certify that I seek the advice and treatment of Paul Dagesse or
Barbara Dagesse or Dagesse CRA®/Wellness LIVE90 solely in my personal capacity,
and do not represent any governmental agency, law firm, attorney, or investigator. I am
not involved in a lawsuit nor am I gathering information for a potential lawsuit.
I understand and agree on behalf of myself, my dependents, heirs, administrators, legal
representatives, and assigns, to release and hold harmless Paul Dagesse or Barbara
Dagesse or Dagesse CRA®/Wellness LIVE90, and all associates, employees, agents,
and representatives thereof, from all liability for illness, injuries, or death, and for any
losses or damages relating thereto, however occurring, in relation to my consultation
with and/or treatment by Paul Dagesse or Barbara Dagesse or Dagesse
CRA®/Wellness LIVE90. Without limitation, I understand and agree that neither Paul
Dagesse nor Barbara Dagesse nor Dagesse CRA®/Wellness LIVE90, nor any
associates, employees, agents or representatives thereof, is liable for any direct,
indirect, consequential, or incidental damage, injury, death, loss, delay, or
inconvenience of any kind which may be occasioned by reason of any act or omission,
including, without limitation, any willful or negligent act or failure to act, or breach of
contract. My acceptance of this via e-contract signature indicates that I have carefully
read and reviewed this Acknowledgment and Waiver of Liability, and I fully understand
all its terms and conditions; I recognize and accept all risks and limitations involved in
seeking advice and treatment therapies from Paul Dagesse or Barbara Dagesse or
Dagesse CRA®/Wellness LIVE90 and associates, employees, agents and
representatives thereof; I have not relied upon any other promises, agreements, or
representations by Paul Dagesse or Barbara Dagesse or Dagesse CRA®/Wellness
LIVE90, or any associates, employees, agents or representatives thereof concerning
the treatment provided or the terms of this Acknowledgment and Waiver of Liability; I
have been encouraged by Paul Dagesse or Barbara Dagesse or Dagesse
CRA®/Wellness LIVE90 to seek the advice of legal counsel concerning this
Acknowledgment and Waiver of Liability; and I execute and deliver this
Acknowledgment and Waiver of Liability freely and voluntarily and without duress or
coercion and with full knowledge of the representations contained herein and the rights
relinquished, surrendered, released, and discharged hereunder. UNDERSTOOD,
ACCEPTED AND AGREED via e-contract.
Your browser does not support viewing this document. Click here to download the document.