Ayurvedic Health Consultation Agreement

I understand that Red Fox Wellness, (“RFW”) and Katherine Hagel are not licensed in the United States to diagnose or treat medical conditions. They may be able to help in my management of my health, and may recommend various things for me to consider in management of my health and energy. They may assist me to learn the differences between medical diseases and the balancing of life energy, which deals with health factors that are within my own control. I may elect to consult a physician prior to seeing RFW, work with a physician concurrently with RFW, or I may decide that my concern about medical conditions does not call for seeing a physician at this time. I understand that I am seeking an educational experience rather than a personal diagnosis of any disease or malady. This educational experience is being provided as part of a seminar on the teaching of the principles of Ayurvedic medicine. The educational experience may involve an examination of me and a demonstration of how Ayurvedic practices would be used to make a diagnosis of particular people. In this experience I may learn of conditions that would be part of an Ayurvedic diagnosis and may hear of the remedies that an Ayurvedic physician would use to treat these conditions. If I choose to use the ideas from the demonstration, I will first present them to a licensed health care provider and obtain his or her evaluation of the efficacy of the approach I wish to use.

I am aware that people may develop pathological conditions (i.e., illness, injury and/or disease) when natural resistance or immunities may be lowered as result of energy and health imbalances persisting for extended periods. However, I am aware that an energy or health imbalance does not necessarily create or reveal the existence of a medical condition. I am aware that recovery from an illness or injury may be facilitated by balancing vital energy, but I am also aware that there may be no way to assure that this effect may occur in any particular case. I certify that I am not seeing RFW for treatment of any physical infirmity or chronic ailment or injury, and that I am seeing them to help manage and strengthen my general health and vital energy. RFW and Katherine Hagel do not recommend the discontinuance of legend drugs or controlled substances prescribed by an appropriately licensed practitioner.

I acknowledge that I have voluntarily requested a consultation with RFW and Katherine Hagel. In consideration of my consultation with RFW and Katherine Hagel, I agree that I (or my heirs, guardians, legal representatives and assigns) will not make a claim or file an action against RFW and Katherine Hagel, and for injury for damage resulting from negligence or other acts, howsoever caused in connection with my consultation with RFW and Katherine Hagel. If I am the parent of a minor who I am asking RFW and Katherine Hagel to consult with, I agree to indemnify and hold harmless RFW and Katherine Hagel from claims or actions made or brought on behalf of my child in connection with RFW consultation. In addition, I hereby waive, release and discharge RFW and Katherine Hagel from all actions, claims or demands I, my heirs, guardians, legal representatives or assigns, now have, or may hereafter have for injury or damages resulting from my participation in my consultation with RFW.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER AND RELEASE OF POTENTIAL LIABILITY AND A CONTRACT BETWEEN MYSELF, RED FOX WELLNESS AND KATHERINE HAGEL, AND I SIGN IT OF MY OWN FREE WILL.