Before beginning Functional Nutrition, please read the following information carefully, then sign and date. For the purposes of this disclaimer, any Oncology support is included in the descriptive "Functional Nutrition".

| FUNCTIONAL NUTRITION GOALS |

The fundamental goal of Functional Nutrition is to encourage people to become knowledgeable about - and responsible for - their own health. A Functional Nutritional Therapy Practitioner (FNTP) helps individuals reach their optimal level of overall health by supporting and bringing balance to the five foundations listed below. All five are built upon a single, solid base: properly prepared, nutrient-dense food. As on Oncology Nutrition Consultant, I am able to help educate you to support the body through prevention, current diagnosis (including treatments such as chemotherapy, radiation, and surgery), and remission.

- Digestion
- Blood Sugar Regulation
- Fatty Acid Balance
- Mineral Balance
- Hydration

By supporting each of these foundations and helping clients adopt a more nutrient-dense lifestyle, the body’s chemistry can be brought back into natural balance, setting the stage for optimal health.

Functional Nutrition is not designed, however, to treat any specific disease or medical condition. An FNTP is trained to evaluate your nutritional needs and make recommendations for nutritional change and nutritional supplements, not medical diagnoses or prescription.

Reaching optimal health requires sincere commitment, possible lifestyle changes, and a positive attitude.  If you are not willing to change how you eat and live, Functional Nutrition is not the right approach for you.  Since every human being is unique on a biochemical level, I cannot guarantee any specific results.

| HEALTH CONCERNS |

If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider. An FNTP is not a substitute for your family physician or other appropriate healthcare provider. An FNTP is not trained nor licensed to diagnose or treat pathological conditions, illnesses, injuries, or diseases, nor prescribe medication.

If you are under the care of a healthcare provider, it is important that you contact your healthcare provider(s) and alert them to your use of nutritional supplements. Functional Nutrition may be a beneficial adjunct to traditional care, and it may also alter your need for medication, so it is important you continue to work with your physician and keep him/her informed of changes in your nutrition.

If you are using medications of any kind, you are required to alert your FNTP to such use, as well as to discuss any potential interactions between medications and nutritional products with your pharmacist. If you have any physical or emotional reaction to Functional Nutrition, discontinue the protocol immediately and contact your FNTP to ascertain if the reaction is adverse or an indication of the natural course of the body’s adjustment to therapy.

| COMMUNICATION |

Every client is a biochemical individual, and it is not possible to determine in advance how your body will react to the nutrients or supplements you need. It is sometimes necessary to adjust your program as we proceed until your body can begin to properly accept targeted nutrients geared to correct imbalances or deficiencies. It is your responsibility to do your part by:

- Following the nutrition guidelines provided by your FNTP
- Avoiding harmful foods, substances, and behaviors
- Moving your body daily
- Getting plenty of sleep, rest, and relaxation
- Staying in contact with me (your FNTP) so I can stay informed of your progress and provide the best course of action going forward

| LICENSURE |

The Nutritional Therapy Association, Inc©  (NTA) certifies individuals as “Functional Nutritional Therapy Practitioner”™ (FNTP©). Note that a Functional Nutritional Therapy Practitioner does not diagnose or treat disease, but instead makes nutritional recommendations for balancing the body and promote optimal wellness. FNTPs are approved by the NTA as a certifying organization, but are not licensed or certified by any state. Please check with your state for specific information on licensing requirements.

An Oncology Nutrition Consultant (ONC) is certified by the Oncology Nutrition Institute, and does not treat or cure cancer. As with Functional Nutrition, an ONC uses specific tools to help identify where the body is out of balance, as well as science-based protocols to help support the body through its cancer journey.

| CLIENT PRIVACY POLICY |

During the course of Functional Nutrition, I will ask that you provide relevant personal details and information relating to your background, health, lifestyle, etc. (hereafter referred to as “Information”), including but not limited to:

Your full name, physical address, email address, telephone number, date of birth, etc.
Your health history, including injuries, surgeries, prescriptions, etc.

This Information will be gathered from you via in person or online interviews, questionnaires, evaluations, intake documents, phone, email, mail, video conferences, etc, and used to:

- Help assess your nutritional needs
- Make recommendations for nutrition changes and nutritional supplements to support your specific nutritional needs and goals
Comply with all legal and NTA training obligations

To ensure the maximum benefit of Functional Nutrition, it is important that your information is accurate and up-to-date. If you notice any changes to your health, begin taking a new prescription, etc, please notify me as soon as possible.

Though FNTPs and ONCs are not HIPAA regulated entities, the NTA is committed to protecting client privacy and requires graduates to uphold the privacy best practices and the policies laid out in the U.S. Standards for Privacy of Individually Identifiable Health Information. I will take all reasonable steps to protect your Information from unauthorized access, use, or disclosure by using strong passwords, up-to-date software on all devices, and locking file cabinets for physical documents. However, even the best security practices cannot guarantee that all stored data will be completely free from third-party interception or corruption.

In accordance with Standards for Privacy of Individually Identifiable Health Information, your consent is required for me to collect, use, and disclose your personal Information. By signing below, you acknowledge your consent for me to collect your Information.

| SIGNATURE REQUIRED |

By signing below, I confirm that I have read and fully understand the above disclaimer, am in complete agreement thereto, and do freely without duress sign and consent to all terms contained herein: