I also understand that it is my responsibility to discuss any and all information provided during this consultation with my primary health care provider or any other health care providers/specialists whose care I may be under.

I, the undersigned, assume all responsibility for decisions I make regarding my health, recognizing that:

1. No claims are made for herbal medicine, nutritional or dietary recommendations to treat or cure any medical condition.
2. All information given is for educational purposes only.
3. There is no implied or stated guarantee of the success or effectiveness of any specific treatment plan or guidelines.
4. I am free to act upon or disregard the recommendations of Real Old Remedies Inc. as I so choose.

I hereby release Real Old Remedies Inc. from all responsibility for my actions and any consequences thereof in the present time and in the future with no constraints. I hereby affirm that I consent and agree to the above statements of my own free will and request to engage the services of Real Old Remedies Inc. in a professional relationship pursuant to the statements herein.

Due to privacy regulations, your information will be held confidential and not shared with anyone.