Fullscript Account Request
Please fill out this form to have Cynthia Thurlow open a Fullscript Supplement account for you
E-mail *
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Your Name: *
Your Email Address: *
Your Cell Phone Number *
Supplements you are interested in *
SIGNATURE REQUIRED HERE: I, hereby accept all risks associated with opening a Fullscript Supplement account with Cynthia Thurlow, who is engaged in the business of various programs for the purpose of improving nutritional habits in order to improve health and well-being and whereas, the participant is desirous of having an account where they can order supplements. Now, therefore, in consideration for the foregoing premises and other good and valuable considerations, the receipt and sufficiency of which are hereby acknowledged, it is agreed by and between the parties as follows: Cynthia Thurlow, assumes no liability or responsibility for personal injuries/problems incurred by the participant due to any supplements participant orders. The participant, hereby, on behalf of the participant, his or her family, heirs, assigns, successors and legal representatives, expressly releases and discharges Cynthia Thurlow from liability in connection with the supplements or from any cause whatsoever, including negligence, and the participant expressly assumes any and all risk in connection with the ordering of supplements via Fullscript. It shall be the participant’s responsibility to consult with his or her healthcare provider as to the appropriateness of the supplement being taken by the participant.   *
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