Visualizing Health and Happiness with Salutogenesis Today - Medical Disclaimer

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Functional Nutrition Counselling Agreement

We are embarking on a journey to a better, healthier you. I want to be sure that you understand how this will work,

and that you are comfortable with the process. In that regard, please confirm your agreement with the following;

by signing up to any of SalutoGenesisToday programs, You agreed to the following:

1- I need some personal information such as age, medical history, medications and nutritional supplements

you may be taking, in addition to other details to complete your nutritional assessment today and to

design a personal nutrition care plan for you.

2- Your personal nutrition care plan may include specific recommendations to change the type of food

choices (foods & beverages) you may be taking, the quantity being consumed, and or when the food

choices are being consumed. You may be provided with herbal infusions like teas, for example and you

understand that is your choice to take them and you agree to hold Milva Di Lorenzo C.F.N.C. and

SalutoGenesisToday, harmless of any claims related to treatment outcomes.

3- Your personal nutrition care plan may require you to complete various activities such as keeping track of

the foods that you ingest on a daily manner for a specific time frame.

4- If you choose not to complete the program that you have signed up for and made payment for, there will

be no refunds and sessions can not be transferred to family members or friends.

5- I understand that Milva Di Lorenzo is a Certified Functional Nutrition Counselor, and she provides

education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviors

associated with eating. While nutritional and botanical support can be an important compliment to my

medical care, I understand nutrition counseling is not a substitute for the diagnosis, treatment, or care of

disease by a medical provider.

6- I understand that Milva Di Lorenzo C.F.N.C. will keep therapy notes as a record of our work together.

These notes document the topics that we talk about, interventions used, and treatment plan or any other

considerations that may be helpful to your work with me. Records will be stored in a secure location.

7- I agree to hold Milva Di Lorenzo C.F.N.C. and SalutoGenesisToday, harmless for claims or damages in

connection with our work together. This is a contract between myself and, Milva Di Lorenzo C.F.N.C and

SalutoGenesisToday, and I understand that it is also a release of potential liability.