Blue Heron Academy
Medical Director

 Waiver of Liability 

I, ____________________________ (Print Name),

1. I accept full responsibility for my health and voluntarily complete this Waiver of Liability.
2. I certify that I am seeking analyses and/or therapies that may not be FDA registered or approved and may not be offered by most other allopathic physicians. They may be considered experimental.  These include, but are not limited to, Metabolic Balance Indicators, Darkfield Microscopy, Electrodermal Screening, SCENAR Biofeedback, Low Level Laser Therapy, Electo-Lymphatic Therapy, Photon Sound Beam, Allergy Removal Technique, Thermal Bed Massage, and Detoxification.
3. I certify that I am not representing any governmental agency in any capacity.
4. I certify that I am not representing any law firm or attorney. 
5. I certify that I am not involved in a lawsuit nor am I gathering information for a pending lawsuit.
6. I agree not to file a lawsuit against Linda Hegstrand, MD nor any of her associates, employees, agents or independent contractors in any lawsuit that I may file against a third party. I also understand that Linda K. Hegstrand, M.D. is acting as an alternative health care consultant.  I understand that she is not acting as a conventional medical doctor.  As such, Dr. Hegstrand is not a primary care physician, and I do not view her as my primary care physician.  Her practice specializes in a natural approach to healing including, but not limited to, nutrition and energy. She does not deal with medical emergencies and does not maintain hospital privileges.  I also understand that Dr. Linda Hegstrand formerly practiced pathology and is board certified in both anatomic and clinical pathology and is not trained as a family practitioner nor internist.  I enter into this Waiver of Liability voluntarily.  I understand that it applies to all of the therapy, care and advice given to me or my family by the Complete Wellness Center and its affiliates.

Signature_____________________________    

Date________________

Witness_________________________

Witness (Printed) _____________________________