Informed Consent Statement

Choice Health Services  

I,    (insert your name in the box)  understand and accept the following:

 1. I understand that Ruby Walmsley is a Natural Holistic Health Consultant  who works with the principle that the body can heal itself once it attains sufficient strength to do so. Ruby uses the principles of kinesiology and her knowledge in health supplements and techniques to assist in determining how to strengthen the body. This information is offered solely to share and illustrate certain principles and practices, to this end, so that others may benefit from them as she has. It is the client’s choice to follow any such presented information. 

2. I fully understand that Ruby Walmsley is NOT a licensed physician and cannot diagnose diseases, prescribe drugs or claim to treat specific disease conditions.  

3. Ruby Walmsley does not claim to cure, prevent or mitigate any disease condition through sharing the knowledge of any holistic techniques or products. Included in these categories are herbs, natural supplements and therapy techniques. 

4. I certify that Ruby Walmsley has not suggested I cease any medical care I may currently be undertaking. I understand that the decisions I make regarding my health care and the health care of those under my guardianship are my responsibility. I understand that a choice for primary consultation with a medical doctor for any serious or life-threatening disease, either for myself or those under my guardianship, is my choice if I deem it so necessary. 

5. I understand that Ruby Walmsley believes that many diseases are related to unresolved emotional stresses and patterns. I understand that any assistance she may offer in this area is done on a spiritual basis and does not replace licensed psychiatric care or professional counseling.   

6. I also acknowledge that I have read the disclaimer posted on this website and understand that it defines that all information on this website or from the Choice Holistic Health Center is for educational purposes only.

Signature: _____________________________________________ 

(Copy of this form to be mailed or faxed)* 

Month    Day   Year

*This form may be submitted to initiate the process of any offered consultation service but must also be faxed with the individual's signature to 250-743-7505 before any information is provided to individual either by e-mail, mail or other form of communication.