Consent Form

Why We Ask You to Sign a Consent Form

We ask every client to sign a consent form so there is clear understanding and transparency about the services we provide.

Health Little by Little Inc. is not a medical practice, and our services are intended to support general wellness, education, and lifestyle guidance — not to diagnose, treat, or cure medical conditions.

In short

The consent form ensures you understand what we do, what we don’t do, and that you are choosing to participate in wellness services — not medical treatment.

First Name

Last Name

Select an Address

Phone

CONSENT and ACKNOWLEDGEMENT

I, THE UNDERSIGNED, hereby understand and acknowledge that Health Little by Little Inc. is not a medical practitioner and that he/she:

does not hold himself/herself out as being able to diagnose, treat, operate or prescribe for any human disease, pain, injury, disability or physical condition.
does not offer or undertake by any means or methods to diagnose, treat, operate, or prescribe for any human disease, pain, injury, disability, or physical condition; and
Cannot and will not give medical advice.

I HEREBY CONFIRM AND ACKNOWLEDGE THAT:

ALL INFORMATION, OR COMMUNICATION WITH Health Little by Little Inc. was at my own request, with full knowledge of the above particulars; and
No guarantees have been made to me concerning the results that may be obtained because of my consultation with Health Little by Little Inc.
No personal information shall be disclosed to third parties without the consent of the individual to whom the information relates.

By checking the box before signing, you confirm that you have read, understood, and consent to the information outlined above.

Thanks for submitting!