Disclaimer & Consent
WELLNESS/ LABWORK TESTS:
At my own will, I 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.
SKIN WELLNESS AND/OR DETOX PROGRAM:
- I hereby request and consent to the performance of all aspects of the Detox and/or Skin Wellness program provided by Unique Verve, Inc, Functional Medicine and Skincare Practitioner Natalie Maibenko.
- I am consenting to submit to participate in the Detox and/or Skin Wellness program of my own free will, that I will accept any and all responsibility for any undesirable consequences that may occur. I understands that it is my sole responsibility to consult with my physician prior implementing the Detox and/or Skin Wellness program.
- I understands that method of the Detox and/or Skin Wellness program involves taking nutritional supplements, recommendation for lifestyle and nutritional changes.
- I understand that the Detox program is a private outpatient program that is non-refundable.
- I certify that I am here on this and on any subsequent visit or contact, whether by mail, telephone, or in person solely on my own behalf and not as an agent or representative of any federal, state, county, or local government or private agency on a mission of entrapment or investigation.
- I understand that due to the nature of the Detox and/or Skin Wellness program, it might involve cleansing reactions in the form of fatigue, headache, or other symptoms. These symptoms will abate with time. Because all individuals are unique, Unique Verve, Inc and a Functional Medicine Skincare Therapist, Natalie Maibenko can not gauge or guess client’s reaction(s) to the Detox and/or Skin Wellness program.
- DISCLAIMER and CONDITIONS: Functional Medicine and Skincare Therapist, Natalie Maibenko encourages the Client to continue to visit and to be treated by his/her healthcare professionals, including, without limitation, a physician. The client understands that Natalie Maibenko is not acting in the capacity of a doctor, licensed dietitian-nutritionist, therapist, psychologist or other licensed or registered professional. Accordingly, the client understands that the Functional Medicine and Skincare Therapist 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, Functional Medicine and Skincare Therapist Natalie Maibenko serves as a coach, 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. The Client has chosen to work with the Functional Medicine and Skincare Therapist Natalie Maibenko and understands that the information received should not be seen as a medical or nursing advice and is not meant to take the place of the client seeing licensed health professionals. Nutritional, fitness, and wellness information provided by Functional Medicine and Skincare Therapist Natalie Maibenko, Unique Verve Inc is designed for educational purposes only. This information is not a substitute for, nor does it replace professional medical advice, diagnosis or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional.
- PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS
The Client acknowledges that the Client takes full responsibility for the Client’s life and well-being, as well as the lives and well-being of the Client’s family and children (where applicable), and all decisions made during and after this program. The Client expressly assumes the risks of the Program, whether or not such risks were created or exacerbated by the provider. The Client releases the Functional Medicine and Skincare Therapist Natalie Maibenko, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders, employees, teachers, lecturers, agents, health counselors and staff (collectively, the Releases) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releases, the Client ever had, now has or will have in the future against the Releases, arising from the Client’s past or future participation in, or otherwise with respect to, the Program. Unique Verve, Inc and the Functional Medicine and Skincare Therapist, Natalie Maibenko is in no way liable for client’s health or safety.
- The Functional Medicine and Skincare Therapist, Natalie Maibenko, is not a licensed Dietitian, Naturopathic Doctor or Medical Physician or Doctor and does not diagnose diseases, disorders or conditions.
- Nutritional, fitness, and wellness information provided by the Functional Medicine and Skincare Therapist Natalie Maibenko, Unique Verve Inc is designed for educational purposes only. This information is not a substitute for, nor does it replace professional medical advice, diagnosis or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional.
- Any claims made with respect to dietary supplements, including those made with respect to supplements available at Unique Verve Inc by the Functional Medicine and Skincare Therapist Natalie Maibenko, 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. The client should consult with a healthcare provider before beginning any dietary supplement program.
- In providing wellness program to the client, the Functional Medicine and Skincare Therapist, Natalie Maibenko, is relying upon the truth, accuracy and completeness of all information the client have provided to her. Any recommendations the client follows for changes in diet, including the use of nutritional supplements, are entirely client’s responsibility.
- NO GUARANTEES
The role of the program is to support and assist the client in reaching the goals, but the success depends primarily on the client’s own effort, motivation, dedication, desire commitment and follow-through.
The Functional Medicine and Skincare Therapist, Natalie Maibenko does not guarantee that the client will attain a particular result, and the client understands that results differ by each individual. As with any health-related program or service, the results may vary, and will be based on many variables, including but not limited to, client’s individual capacity, life experience, unique health and genetic profile, starting point, expertise and level of commitment.
- The client understand that any therapies that she/he undertakes at Unique Verve, Inc are undertaken of her/his own free will.
The client accepts that the ultimate responsibility for her/his health care is the client’s own and that the Functional Medicine and 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 has read the above release and waiver of liability, and fully understands its contents and voluntarily agrees to the terms and conditions stated.
I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO THE TERMS OUTLINED ABOVE. I UNDERSTAND THIS AGREEMENT TO BE A FULL AND FINAL RELEASE OF ALL COSTS, CLAIMS, CAUSES OF ACTION AND DAMAGES OF ANY KIND ARISING FROM OR IN CONNECTION WITH THE WELLNESS PROGRAM offered by the Functional Medicine and Skincare Therapist Natalie Maibenko, Unique Verve, Inc.
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