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Terms of Service

Consent Form

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                                                              Paragon Health Centre

 

                                                                TERMS OF SERVICE

                                                                  CONSENT FORM

                                                   Name: ______________________________      

                                      (Ref:     Health & Disabilities Act 2000, The Privacy Act 1993)

 

                                                               Epigenetic Hair Scanning

I acknowledge the following parameters of the Cell Wellbeing epigenetic hair scanning procedure:

* The Cell Wellbeing 90 day booster program provides recommendations on diet and supplements to optimise the condition of the body.

* A report will be produced as a result of epigenetic scanning techniques. This will identify areas of diet and vitamin/mineral excesses or deficiencies that affect the homeostasis of my body.

* The report will recommend an optimized diet and supplement regimen calculated to parallel the existing condition of my body.

* The primary goal of the program is to control calorie intake, protein and fibre levels and optimize health and well-being.

* To enhance this goal various vitamin and mineral will be recommended sourced from Metagenics, an Australian company which provides ‘practitioner only’ supplements.

* These supplements are more potent than Japanese counterparts and consequently are more effective for the 90 day ‘booster’ program.

* As they are more highly concentrated, (most of) the supplements recommended should be taken 5 days on 2 days off, to allow the body to assimilate the changes on a gradient.

 

* It is anticipated that after 90 days of strict adherence to the program, there will be an observable boost in your homeostasis.

* A second scan would then be advisable to fine-tune any further improvements.

                                                                  Terms of Service

* The recommendations of this service are recommended by trained supplement advisors who have graduated with a JSADA diploma in Japan.

 

* For medical advice, medicinal prescriptions or diagnosis of medical conditions, please consult your own doctor.

* I have been advised that certain diets and supplements are not suitable if I am pregnant and I have advised my practitioner if I am pregnant.

* All procedures will be clearly explained during the consultation.

* I have the right to decline or withdraw my consent at any time.

* I understand that any records kept by Paragon Health Centre will only be released upon my permission, and that during these times my identity will be protected and privacy maintained.

 

* I have the right to see any information held by Paragon Health Centre.

* I have read, or had read to me, this consent document and I understand what has been explained to me, and have asked any questions I may have about its content.

* I understand and accept that failing to adhere to the diet and supplements recommended will minimise (or negate) the efficacy of the program.  

* You can sign and return this document with your payment or alternatively tick the box  'Terms of Service'  on your invoice to signify you have accepted the tems stated above.

                                                                                Signature:

 

                                            Name           _______________________________

                                                                          (BLOCK CAPITALS)

 

 

                                           Signature:    _________________________________

                                 (Written consent from Guardian or Parent is needed before 

                                               accepting minors - 16 years and under)

 

                                           Signature:   _______________________________

                                                     (Custodial Parent / Legal Guardian)

 

                                            Date:           _______________________________

Contact

Paragon Health Centre

0267 34 0182

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