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Waver
Alva Irish, PhD, DD, DN, DHM, FIBH
236 Fuller Drive Easley, SC 29640
864-605-0474
Offices in Greenville SC, Spartanburg SC, Anderson SC and Columbia SC.
 
CONTRACT OF AUTHORIZATION IN THE HOMEOPATHIC & NUTRITIONAL HEALTH ANALYSIS PROCEDURE FOR ENERGY EVALUATION
 
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PLEASE READ CAREFULLY BEFORE SIGNING:
I understand and acknowledge that Dr. Alva Irish is NOT a Medical Doctor, Psychiatrist, Veterinarian, or any other kind of Doctor of Medicine, nor does she hold herself out as one. I also understand and acknowledge that Dr. Alva Irish is a Doctor of Homeopathy and a Doctor of Naturopathy.

I hereby authorize Dr. Alva Irish, and her representatives to act on my behalf concerning Homeopathic and Nutritional Health Analysis Procedure for Energy Evaluation. I specifically authorize her to perform a Homeopathic and Nutritional Health Analysis Procedure for Energy Evaluation and develop for me a suggested Nutritional and Homeopathic Health Program.

I warrant that all information submitted for analysis and evaluation was submitted by me and is true to the best of my knowledge.

I recognize that the Homeopathic and Nutritional Health Analysis Procedure is an established method that is not yet approved by the medical profession, or the Food and Drug Administration, although it has not been rejected.

I acknowledge that the Homeopathic and Nutritional Health Analysis Procedure, the Evaluation, the Research on the Zizia program, the Hair Analysis and the 
suggested Nutritional Health Program are not for diagnosis, treatment, care, alleviation, mitigation, prevention, or care of any disease of any kind, in any way. However, I reserve the right to use the knowledge I gain in the care of my own body in any legal manner I may choose, including the suggested Homeopathic and Nutritional Health Program.

I understand that although I have been requested to give all of my symptoms, they are for research purposes to find in the Zizia program the historic use of those Homeopathic remedies that match those same symptoms, and are not meant to be used to diagnose or treat any disease or condition of any kind.

I hereby attest and affirm that I am here as a client/student, on this and any subsequent visit, solely on my own behalf.
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By signing I accept and understand this waiver

Date:________________________________________

Client:_______________________________________

Address:_____________________________________

Phone:_______________________________________
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