DECLARATION OF INFORMED CONSENT AND STIPULATIONS REGARDING HOLMES HEALTH SERVICES
I understand that Jenny Holmes has a degree in Natural Medicine and functions as a Bio-Cell Technician, and that she is not a licensed N.D. M.D., D.O., or D.C., and is not licensed in the State of California as a N.D. I understand and acknowledge that Jenny Holmes of HOLMES HEALTH does not diagnose or guarantee treatments for curing me of any disease or afflictions. She is not a medical professional & does NOT hold medical records. I understand that her advice and treatment is based on her training, research, expertise, and experience and reflects her professional judgment of how to help me to the fullest extent.
I understand that her work is for the betterment of cellular biology research. My sole purpose and intent in seeking the services of Jenny Holmes is due to the fact that I feel it will be helpful in guiding my healthcare plan. I take full responsibility with regards to my health, my healthcare protocols, and their results.
I understand that Holmes Health is not a Medicare or Medicaid provider and that my receipt or invoice is not to be submitted to Medicare or Medicaid. In good faith, I accept to pay cash and engage the services of Jenny Holmes of Holmes Health and do hold her harmless for the services she has or will render.
I have read (or have had read to me) this Declaration of Informed Consent to services, contract and stipulations, and agree to be bound by the terms therein. I understand that I may ask any questions useful in helping me understand it. I further understand my agreement to the provision of this declaration is an entirely voluntary and informed choice to which my signature attests.
This page will be given to you before your appointment with Holmes Health is conducted. A signature will be required to proceed with your appointment.