Assumption of Risk and Release of Liability

I hereby acknowledge and agree:

1. The purpose of nutritional counseling is to improve the overall health, vitality and well-being of the body through nutritional education and the use of foods and non-medicinal nutritional supplements. Naples Nutrition, LLC nor Danielle Naples does not diagnose diseases, disorders or conditions.

2. Danielle Naples is a registered and licensed Dietitian, NOT a Medical Doctor.

3. As part of the Nutritional Counseling Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. This information is collected to enable Naples Nutrition, LLC and/or Danielle Naples to: (i) assess my knowledge of nutrition, (ii) education me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality and overall well-being. Naples Nutrition, LLC/Danielle Naples will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.

4. If Naples Nutrition, LLC or Danielle Naples suspects the existence of disease, disorder or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Medical Doctor about any suspected problems.

5. Should I request Naples Nutrition, LLC and/or Danielle Naples to recommend dietary changes and/or nutritional supplements to enhance my body’s natural ability to resist and/or overcome a known disease, disorder or condition, it is my responsibility to disclose the nature of the disease, disorder or condition and all other relevant details to Naples Nutrition, LLC and/or Danielle Naples. If I have not previously consulted a licensed Medical Doctor about this disease, disorder or condition, I acknowledge that I am directed to promptly do so. I am not to alter or discontinue treatments prescribed by a licensed Medical Doctor or other licensed health professional without consulting the individual who prescribed the treatment.

6. In providing Nutrition Counseling Services to me, Naples Nutrition, LLC and/or Danielle Naples, is relying upon the truth, accuracy and completeness of all information I have provided. Any recommendations I follow for changes in diet, including the use of nutritional supplements, are entirely my responsibility.

7. Naples Nutrition, LLC and/or Danielle Naples is in no way liable for my health or safety. That is my own responsibility.

8. In consideration of my participation in the Nutritional Counseling Services, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release Naples Nutrition, LLC and/or Danielle Naples on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in the Nutrition Counseling Services, whether caused by negligence or otherwise.

9. Twenty-four hours (24 hours) is required for cancelling appointments. Appointments cancelled within twenty-four hours (24 hours) of the scheduled appointment time will be billed at 50%. Prepayments will be refunded at 50%. Services are non-billable to insurance and a superbill will not be provided.

10. I understand that any therapies I undertake at Naples Nutrition, LLC are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Naples Nutrition, LLC and/or Danielle Naples is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.

11. Any mention of drugs in the course of consultation is only for the purpose of providing a complete history of drugs that the client is taking and not for Naples Nutrition, LLC and/or Danielle Naples to judge the appropriateness of the medication. Any change in prescription or dosage is a decision the client makes with his or her physician.

12. Rather than dealing with treatment of disease, Danielle Naples focuses on wellness and prevention of illness through the use of non-toxic, natural nutritional therapies to achieve optimal health. As a registered dietitian and functional medicine specialist, Naples Nutrition, LLC and/or Danielle Naples primarily educates and motivates clients to assume more personal responsibility for their health by adopting a healthy attitude, lifestyle, and diet.

13. While people generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and diet, Naples Nutrition, LLC and/or Danielle Naples does not promise or guarantee protection from future illness.

14. I acknowledge that I understand that Naples Nutrition, LLC and/or Danielle Naples is not a physician, and that I should see a doctor if I think I have a medical condition. Naples Nutrition, LLC and/or Danielle Naples will not be held liable for failure to diagnose or treat an illness, nor will she/he be liable for failure to prevent future illness.

15. In addition, I will give Danielle Naples a complete and accurate account of any medical conditions that I may have and any medications that I am taking.