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Consent for HALO Coaching

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JoHanna Chan HALO Wellness Coach

JoHanna Chan HALO Wellness Coach

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Consent for HALO Coaching

Consent for HALO Coaching

1About You

2About Your HALO

3Disclaimer

Tell JoHanna About You
Name
First Last
Gender
- Male
- Female
Age
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Work Phone
Email Address (It will never be shared.)*
Other (e.g.., Skype Name)
Check the Best Way to Reach You.
- Email
- Home Phone
- Cell Phone
- Work Phone
Best Time To Reach You*

About HALO
How Did You Hear About the HALO?
When did Your HALO arrive?
Please check all the following that apply to you:
- I have read the HALO Manual thoroughly and consult it regularly.
- I have viewed the training materials on the HALO site.
- I have called customer service.
- I have attended HALO Q&A calls.
Indicate how many times you called customer service.*
How many times have you attended HALO Q&A calls?*
Please give me a brief overview of the issue(s) you want to address with the HALO:

HALO Coaching Scope and Disclaimer
The words that will be used on the coaching call with you that may coincide with medical terms such as diagnosis, patient/client, therapy, treatment, and healing are not to be interpreted by you in a legal sense.

The HALO Ultra Blue and/or MAX Unit have not been evaluated by the Food and Drug Administration (FDA) and are not intended to TREAT, PREVENT, MITIGATE or CURE any medical, emotional, or psychological condition, or to support or sustain human life, or to prevent impairment of human health; it is for self-education purposes only.

No medical, health, healing or any other related claims are intended or asserted. A HALO coach claims no “typical results” exist and what you may experience from using the HALO Ultra Blue or MAX Unit may be completely different from someone else.

It is important to understand that the HALO DEVICE DOES NOT HEAL but it does support the body's ability to self-heal.
The statements made on HALO Coaches calls do not necessarily represent the views of Dr. Alex Loyd or Dr. Alex Loyd Services, LLC; they are entirely the view of the HALO Coach. I hereby release and hold harmless Michael Thomas, Halo Multiverse and Alex Loyd, Dr. Alex Loyd Services, LLC and all HALO Coaches from liability for harm, and to hold same harmless from all claims, regarding the use or misuse of my HALO device.
I have read, understand, and agree with above Disclaimer*
- I agree with above Disclaimer
Type Your Name*
Date
MM slash DD slash YYYY

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