COMPREHENSIVE HEALTH HISTORY ASSESSMENT

At my own will, I (the purchaser and/or end user of the Wellness Lab Test) give a permission to request Natalie Maibenko, Unique Verve, Inc to order wellness test(s) through Vibrant America.

I hereby acknowledge and agree that the test(s) need to be pre-paid in full. I understand and agree that the test(s) is/are not refundable.

I give Natalie Maibenko, Unique Verve, Inc a permission to receive and review ordered test results which will be e-mailed to me through a HIPAA compliant website.

I do not hold Natalie Maibenko, Unique Verve, Inc and Vibrant America accountable for ordering the test(s) and receiving test results.

I hereby acknowledge and agree that the Vibrant America test(s) ordered/purchased through Natalie Maibenko, Unique Verve Inc is/are designed for educational purposes only. This information is not a substitute for, nor does it replace professional medical advice, diagnosis or treatment.

DISCLAIMER OF HEALTH CARE RELATED SERVICES

The Client is encouraged to continue to visit and to be treated by his/her healthcare professionals, including, without limitation, a physician. The Client understands that the Functional Medicine Skincare Therapist, Natalie Maibenko is not acting in the capacity of a doctor, licensed dietitian-nutritionist, therapist, psychologist or other licensed or registered healthcare professional. Accordingly, the client understands that Natalie Maibenko is not providing health care, medical or nutrition therapy services and will not diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Functional Medicine Skincare Therapist, Natalie Maibenko serves as a mentor and guide who helps a client to reach her/his own health and wellness goals through implementing incremental, positive, healthy, sustainable lifestyle changes that help the client to live and thrive using simple methods.

Nutritional, supplemental, fitness, and wellness information provided by the Functional Medicine Skincare Therapist, Natalie Maibenko, Unique Verve Inc is designed for educational purposes only. If the Client has any concerns or questions about her/his health, the Client should always consult with a physician or other healthcare professional. Do not disregard, avoid, or delay obtaining medical or health-related advice from the healthcare professional.

Any claims made with respect to dietary supplements, including those made with respect to supplements available at Unique Verve, have not been evaluated by the Food and Drug Administration, and is not necessarily based on scientific evidence from any source. Dietary supplements are not intended to treat, diagnose, cure or prevent medical conditions or disease. You should consult with a healthcare provider before beginning any dietary supplement program.

The Client understands that any therapies that the client undertakes at Unique Verve, Inc are undertaken of the client's own free will. The Client accept that the ultimate responsibility for her/his health care is her/his own and that Functional Medicine Skincare Therapist, Natalie Maibenko, Unique Verve Inc is here to support the client in this. The client hereby agrees to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and the Client, her/his heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of the Client's attendance and/or participation.

The Client have read the above release and waiver of liability, and fully understands its contents and voluntarily agrees to the terms and conditions stated.