SAFE PRACTICE AGREEMENT

Thank you for choosing Nutritional Artistry LLC to guide you on your path to optimizing your overall health through nutrition and functional medicine. By signing below, you acknowledge that any dietary, supplement, or homeopathic suggestions made by Ilianna Paschalidis of Nutritional Artistry LLC are based on supporting a healthy lifestyle and are not intended as a diagnosis, cure or treatment for any disease of ailment. If you have a specific condition requiring treatment outside of the scope of my practice, you must first consult your primary care physician and/or place yourself under the care of a medical care specialist for that specific diagnosis.

By signing this agreement, you are acknowledging the following as being true:
1) The information I have supplied in my health screening forms is correct to the best of my knowledge.
2) I understand that I am participating in a program that may involve lifestyle changes including nutrition, dietary supplements and physical activity.
3) I understand that before participating in any nutrition or exercise program, I should consult my physician. I also understand that participation in these programs may involve risks.
4) I take full responsibility for my participation in these programs, and hold harmless Nutritional Artistry LLC and Ilianna Paschalidis from any claims of injury and/or illness that may arise during or after my participation in any such program.
5) Minors and anyone under the age of 18 must have their parent or legal guardian sign below assuming full responsibility for their participation in any Nutritional Artistry LLC program, service or suggestion offered by Ilianna Paschalidis. The parent or legal guardian shall also be responsible for all fees related to the minor’s care.
6) By signing below, I acknowledge that I fully understand that in no way are the services rendered by Ilianna Paschalidis of Nutritional Artistry LLC a substitute for medical care and any ailments diagnosed or undiagnosed must be treated by a licensed physician or specialist related to that specific ailment or ailments.
7) I further acknowledge and understand that Ilianna Paschalidis of Nutritional Artistry LLC is not a licensed
R.D., as defined in New Hampshire’s Code of Administrative Rules 102.01 subsection C, and is clearly acting as a nutritional and wellness consultant in accordance with her Master’s in Clinical Nutrition and CBNS Board certification.

Signature

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