I understand that Kelly Parsons holds a certification in Bioenergetic Testing from Qest4. She is also a Certified Holistic Health Practitioner and Certified Nutrition Consultant from Trinity School of Natural Health. She is not a medical doctor or provider. She uses biofeedback technology, nutrition, herbs, essential oils, supplements, and homeopathic products in her consultations. All results from testing are not intended to diagnose or treat any medical condition or disease. The results are provided for my education regarding holistic approaches and the potential of bioenergetic technology in my quest for wellness. Kelly empowers me through lifestyle coaching so that I may reduce my stress and pain, detoxify my body from environmental toxins, support my body through supplementation, and improve the quality of my life so my body can heal itself, which it is innately designed to do. I agree to use Kelly's services to help me learn how to accomplish these things through the foundations of health. These include nutrition, hydration, exercise, rest, energy work, body work, stress reduction, and emotional balance.

I understand that the natural healing consultations provided by Kelly are not a substitute for adequate medical care and I intend to remain under the care of my primary health care provider, including any prescription medications that have been prescribed by my health care provider.

I understand that I am responsible for my own health, healing, and wellbeing. I also understand that I have the ability to heal myself through the choices I make. I understand it is my responsibility to advise Kelly of anything that might help us work together better to achieve the healing and health goals I seek.

I understand my identity and information about me, whether I share it with Kelly or she discovers it on her own, will be held in the strictest confidence, except when released by me or specifically required by law.

I understand that if I have, or think I have a medical concern, condition, disease, disorder, issue, or symptoms, Kelly will help me reduce any related stress and refer me to a licensed chiropractic, physical therapist, or medical physician for further assistance.

I understand the services provided by Kelly may cause some minor discomfort while my body is healing itself and detoxifying, through no fault of my own or Kelly's. If I have concerns, I will keep Kelly fully advised so the intervention may be terminated if necessary or revised.

I have read and understand all the information provided in the policies and procedures form, as well as the informed consent. I understand health and wellness is my responsibility. I agree to use the services of Kelly Parsons as they are laid out above. I understand that I am here to learn about wellness and better health practices, that I will be offered information about food, supplements, and lifestyle choices as a guide to general good health. I fully understand that those who counsel me at Quest for Wellness, LLC are not medical doctors and I am not here for medical diagnostic purposes or treatment procedures. I am not on this visit, or any subsequent visit, an agent for federal, state or local agencies or on a mission of entrapment or investigation. The services performed here are at all times restricted to consultation on holistic health matters intended for the maintenance of the best possible state of natural health, and do not involve the diagnosing, treatment or prescribing of remedies for disease.

The QEST4 system provides a completely non-invasive method for gaining valuable information about an individual's Innate Intelligence and/or energetic field. The primary objective of the evaluation is to disclose energetic imbalances and provide feedback that will assist in developing a program to support each physical and energetic system of the body.

■ I understand that the QEST4 evaluation does not provide a medical diagnosis and that my testing technician may recommend further medical care and testing. If I suspect I need medical intervention, I understand I should consult my physician. I give my permission for the testing technician to evaluate me with the QEST4. I understand in doing so, my testing technician is NOT becoming my primary physician.

■ I understand that the testing technician will give me information about my body's energetic field and make recommendations based on the QEST4 evaluation. I understand that the testing technician will not pass judgments on prescribed medications and it is the responsibility of my primary physician to make any adjustments to prescribed medications or methods of treatment. Any decision to follow through with the recommended protocol is my own decision and I will not hold the testing technician liable.

■ I understand that I am here to learn about natural health and better lifestyle practices, and I will be offered information about food, supplements, and herbs as a guide to supporting my well-being.

■ I understand that I should continue to see any physicians I may be currently under the care of and that any prescribed medications should not be altered without first consulting the physician who prescribed them.

■ I fully understand that those who counsel me may not be licensed physicians. I am not seeking any medical diagnosis or medical treatment in relation to the QEST4 evaluation.

■ I fully understand that information about traditional uses of supplementation that may support balance may be discussed. I fully understand that this information is not intended to be interpreted or used as a substitute for medical care offered by a licensed physician. I fully understand that anything said, done, typed, printed, or presented in any other fashion to me is not intended to diagnose, prescribe, treat, or take the place of a licensed physician.

■ I fully understand that the intent is to provide educational information for the purpose of assisting me with the lifestyle changes necessary to regain and maintain an environment needed to support a well-balanced lifestyle.

■ I am not on this visit, or any subsequent visit, acting as an agent for the federal, state, county, local law enforcement, or news media on a mission of entrapment or investigation.

■ I understand that all information and conversations will be kept confidential, and that information concerning myself may only be released to a health professional with my written consent.

■ I understand that the QEST4 evaluation will only identify energetic imbalances and does not diagnose any diseases. The Balancing Item refers to the energetic signatures needed to restore balance to the body's energetic field. Balancing Items are defined differently from physician terms and are not a cure for any disease.

■ I recognize that the QEST4 evaluation is an unorthodox approach to supporting my well-being. Being of sound mind, of my own free will and in exercise of my constitutional right for the attainment of life, liberty and the pursuit of happiness, I have chosen this evaluation method to assist in balancing my health.