Questionnaire

Disclaimer of Liability and Informed Consent

Please read the Disclaimer of Liability and Informed Consent. Once completed please sign the form above to acknowledge agreement to the terms and conditions:

Thank you for your interest in using Mind Your Macros to improve your general health and to lose weight through a low-carb, ketogenic diet. You may or may not at the same time be under the care of a physician for primary treatment or for the treatment of a specific medical condition. It is important to understand the scope and extent of the services that Mind Your Macros will render in your case. Mind Your Macros and its employees/agents are not physicians or psychologists, and the scope of his/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 Mind Your Macros to judge the appropriateness of the medication. Any change in prescription or dosage is a decision the client makes with his or her physician.

Rather than dealing with treatment of disease, Mind Your Macros focuses on wellness and prevention of illness through the use of non-toxic, natural nutritional therapies to achieve optimal health. In the nutritional guidelines that are personalized for you, Mind Your Macros may suggest vitamins, minerals, electrolytes, and other nutritional supplements. The purpose of these natural products is limited to: improvement of your overall nutritional status, increasing your sense of well being and preventing and treating the “keto flu”. Please consult your physician prior to taking any medications including natural supplements recommended by Mind Your Macros. Mind Your Macros primarily educates and motivates clients to assume more personal responsibility for their health by adopting a healthy attitude, lifestyle, and diet.

The analysis and advice of Mind Your Macros concerning a low-carb, ketogenic diet has not approved by the American Medical Association, the Food and Drug Association, the American Cancer Society, the American Heart Association or similar agencies or organizations. However, there has been significant scientific evidence that consider such nutritional guidelines safe and effective.

People generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and diet. Although a healthy lifestyle and weight loss are the intention and goals of Mind Your Macros. Mind Your Macros does not promise or guarantee weight loss or protection from future illness.
By signing below, you acknowledge that you understand that Mind Your Macros is a health consultant and not a physician, and that you should see a doctor if you think you have a medical condition. Mind Your Macros will not be held liable for failure to diagnose or treat an illness, nor will it be liable for failure to prevent future illness.
Additionally, you promise to give Mind Your Macros a complete and accurate account of any medical conditions that you may have and any medications/supplements/vitamins that you are taking.
You also acknowledge that you desire to undertake diagnostic evaluation and follow suggestions in your case such as nutritional guidelines (macros) and supplements, which appear to be indicated for you under the professional opinion of agents or employees of Mind Your Macros.