Product Declaration
I confirm that this product has been prescribed or recommended this product by a qualified healthcare practitioner.
I confirm that I have used this product under practitioner guidance or am using it for a condition discussed with one.
I confirm that I have previously discussed this health concern with a practitioner (either at this clinic or elsewhere).
I confirm that I disclosed any prescription medications or supplements I am currently taking.
I confirm that I understand this product must be used only as directed and that I will seek our practitioner advice if symptoms persist or worsen.
Medical Conditions
I confirm that I have disclosed any relevant medical conditions, allergies, or health concerns that may affect the safe use of this product.
Pregnancy and Breastfeeding
I confirm that I have informed the practitioner if I am pregnant, planning pregnancy, or breastfeeding, where relevant to this product.
Understanding Product Limitations
I understand that this product is intended to support health and wellbeing and is not a substitute for medical diagnosis, treatment, or emergency care.
Following Dosage Instructions
I agree to follow the recommended dosage, storage instructions, and usage guidelines provided with this product.
Consent to Practitioner Follow-Up
I consent to being contacted by the clinic or practitioner if additional information is required to ensure the safe and appropriate use of this product.
Patient Acknowledgement
I acknowledge and agree to the Practitioner Product Policy and Compliance Statement.
