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INFORMED CONSENT AND LIABILITY WAIVER

The undersigned, being at least twenty one (21) years of age, and in consideration for acceptance, approval and participation in the Herbily Ever After™ Cancer Therapy with Cannabis Program, hereinafter described as THE PROGRAM, does hereby agree to the following consent, waiver, and release of liability.

Acknowledgement and Assumption of Risk

I understand that Herbily Ever After™ is NOT A LICENSED PHYSICIAN OR MEDICAL DOCTOR, nor is Herbily Ever After’s™  services licensed in the United States or anywhere else in the world.

I understand that Herbily Ever After™ is offering assistance, via THE PROGRAM, to people suffering from cancer, which have exhausted unsuccessful treatments from oncologist and doctors, and as a last resort, are willing to try alternative methods of treatment such as medical marijuana (cannabis), CBD (cannabinoids), and herbs and supplements.

I understand that Herbily Ever After™ does NOT not sell marijuana, but DOES sell legal CBD which is 0.3% THC or less.  CBD is legal in most states, but not all.  Herbily Ever After™ will help client choose a cannabis strain and dosage, and help the client locate a place to purchase marijuana, and CBD.

I understand that Herbily Ever After™  is not affiliated with any marijuana dispensaries, and clients have the choice to purchase marijuana at the dispensary of their choosing.  The client also has the choice to either purchase CBD from Herbily Ever After™, or from any outside source.

I recognize that Herbily Ever After™  offers THE PROGRAM, and suggests using marijuana, which is illegal in most states and is listed by the DEA (Drug Enforcement Agency), as a Schedule 1 Drug https://www.dea.gov/drug-scheduling.  THE PROGRAM, also suggests using CBD (cannabinoids), which is illegal in some states, and has not been approved by the FDA.  I understand that it is my responsibility to check to see if marijuana and/or CBD are legal in my state and local government.

I also agree that the PROGRAM may offer other alternative methods to help alleviate pain or tumor regression, which may include nutritional supplements, herbs, extracts, remedies, etc. which have not been approved by the FDA, are taken at my own risk. As with any ingested substance, allergic reaction is a possibility in some individuals, and that I am responsible inform myself of the risks and consequences involved.

I further recognize that using marijuana, CBD, and other herbs, extracts, supplements, carries a health risk, and that it is possible my illness could worsen due to using marijuana and/or CBD, and other risks, which in combination with other medications or my actions can cause serious illness or death.

I agree to seek the advice of my physician or another qualified health care professional prior to and during THE PROGRAM regarding any questions or concerns I have about my specific health situation, possible or actual pregnancy, known or suspected food sensitivities or allergies, dietary restrictions, or any medications I am currently taking.  I agree to not disregard professional medical advice or delay seeking professional advice or stop taking any medications without speaking to my physician or health care professional.

I hereby agree to assume all risks which may be associated with or may result from my participation in THE PROGRAM.

Waiver and Release of Liability

I hereby waive, release and discharge Herbily Ever After™, its directors, officers, employees, or agents from all actions, claims or demands that I, my heirs, guardians, legal representatives or assigns, now have, or may hereafter have for injury or damages resulting from my participation in THE PROGRAM, provided by Herbily Ever After™.

This waiver and release of liability includes, without limitation, all illnesses or death which may occur as a result of any recommendations from Herbily Ever After™

Consent

I, the undersigned participant, affirm that I am at least 21 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this agreement, I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.

I hereby consent to authorize Herbily Ever After™ to offer recommendations for cannabis usage, and possibly, other herbal medicines that may be implemented upon reasonable assessment. I understand that using any herbs may cause illness.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER AND RELEASE OF POTENTIAL LIABILITY AND A CONTRACT BETWEEN ME, AND HERBILY EVER AFTER, AND OR ITS AFFILIATED ORGANIZATIONS, AND I SIGN OF MY OWN FREE WILL.

By signing this waiver, I agree to the above terms and conditions.

Are you sure you want to consent?:

Please write your signature in the box below

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All information provided from the client is kept confidential and will not be disclosed to any party, be they family or medical provider, unless expressly given in writing.

 

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