I, ________________________________fully understand that as a nutritional consultant, Gracie Chukwu's counsel is limited to determining my nutrient status and advising which dietary and supplemental measure would better balance my nutritional make-up. She has been trained on interpreting hair analysis tests by the lab and by other nutritionists. I understand that she is not a medical doctor, nor is pretending to be one. Only a medical doctor can diagnose or treat illnesses. Gracie is only educating me on ways to support my health and overall well being.

I am ordering the hair analysis test solely on my own volition, and desiring her counsel on the results. I am in no way on a mission of deceit or entrapment against Gracie Chukwu or of her profession.

I understand that www.houstonholistichealthcliniccom belongs to Gracie Chukwu and is the ideas, opinions, experience and theories of Gracie Chukwu. The website is her way of sharing her experience with others in order to educate. It is not her intent to substitute a hair analysis or vitamin supplements for a medical checkup, lab work, medication or doctor's visits. This website is not stating that we can diagnose, treat or cure any medical condition.

If I chose to use Gracie Chukwu's advice and her vitamin suggestions, I will not hold her, or the lab she uses, or anyone she works with responsible for any problems that occur. She is not responsible for any damages, law suits, money or property of any kind when I use the products she suggests, read the information on this website, or the results and suggestions she sends to me. She is free from any legal ramifications from me or anyone I know.

I understand that all information I give Holistic Health Clinic on my health is being held in strict confidencer. She agrees not to share it with anyone.

Gracie Chukwu agrees to use my credit card once for the amount I state. I agree that if my credit card number is declined Gracie will try to contact me, but will not send out the hair for analysis until payment is received.

I understand that if my check is returned by my bank for any reason, I may be billed for an additional fee of $25 for processing.

I understand that Gracie will not send the hair sample to the lab prior to receiving payment or having my signature on the order form stating that I understand the disclaimer.

In the questionnaire I will let Gracie know all medication I am taking and all medical conditions I have.

I agree to let Gracie know if I am or become pregnant while I am receiving her counsel.