Informed Consent/Authorization

The following Statement of Informed Consent and Authorization is established protocol regarding the products and services being offered by HealthyKidneyStore.com. This may include access to in-person, electronic and/or telephonic consultation services. You as the consumer agree to accept responsibility for your decision to seek any and all services/products offered by HealthyKidneyStore.com.

To ensure your compliance with the Terms stated herein, HealthyKidneyStore.com reserves the right to monitor product/service usage of any products and/or services offered through or obtained from HealthyKidneyStore.com. HealthyKidneyStore.com can, in its sole discretion, refuse access to any and all products and/or services due to actual, potential or perceived misuse/abuse of the site, related products/services, or for noncompliance with any of these Terms.

In order to fulfill and process any product and/or service inquiries, requests, and/or transactions, you hereby agree that you have read and understand these conditions, including the Statement of Customer Responsibility.

 

Statement of Customer Responsibility

By transmitting my health/other personally identifiable information in connection with my request for services/products, specifically, any or all health coach customer support services offered as a part of product purchase, I assert the following to be truthful statements:

1. I am at least 21 years of age.
2. I voluntarily choose to seek out the products and/or services offered through HealthyKidneyStore.com.
3. I can competently use the products and/or services offered by HealthyKidneyStore.com, and I fully understand the nature of the services/products provided.
4. I understand that HealthyKidneyStore.com receives electronic transmissions of any consultation/service requests; directs my information to a consultant for their review and response in accordance with the consultant’s professional judgment as to my request.
5. I understand that any and all health coaching provided as a complimentary bonus to my purchase is provided by an independent, U.S. licensed practitioner; and not a physician.
6. If paying by credit or debit card, I am the owner of that credit or debit card or I am permitted by law to use such credit card.

 

Customer Agreement and Acknowledgement:

As a potential customer of the products provided by or through HealthyKidneyStore.com, I hereby understand, accept, and agree to the following:

In order to determine your compliance with these Terms, we reserve the right to monitor access to/use of HealthyKidneyStore.com and any related services and/or products. HealthyKidneyStore.com may, in its sole discretion, refuse to provide access to the site or services due to actual or potential misuse of the site, these Services, or for noncompliance with these Terms.

I acknowledge that Dr. Robert Galarowicz, HealthyKidneyStore.com as well as any of its employees do not practice medicine and are not healthcare service providers.

Additionally, I acknowledge that HealthyKidneyStore.com cannot and does not influence, control or direct any opinions or decisions made by the consultant/affiliate/associate and/or any other assigned employee with respect to my care.

I accept all risks, known and unknown, involved in, arising from or related to using the products or recommendations obtained through or from HealthyKidneyStore.com. Subject to and without waiving any rights that may be conferred upon me under state or federal law, I will not seek indemnification and/or damages whatsoever of any kind from HealthyKidneyStore.com for negligent, reckless or intentional acts or omissions, and I hereby hold harmless HealthyKidneyStore.com from and against any and all liability relating to or arising out of my request for or receipt of products, recommendations and/or any other services from HealthyKidneyStore.com.

I acknowledge that any and all testimonials and/or reviews expressed on HealthyKidneyStore.com represent only a cross section of the range of results that appear to be typical with sustained used of these products.

I hereby acknowledge that all information and service provided by or through this web site and company are provided “as is” without warranty of any kind, expressed or implied.

If any provision of this agreement is held to be illegal, void or unenforceable, then this agreement may be modified or amended only to the extent necessary to enable the remaining provisions to be of force and effect to the maximum degree.

 

Client Authorization for Release of Individually Identifiable Health Information

In connection with providing certain individually identifiable health information to HealthyKidneyStore.com, I authorize the following:

I hereby authorize HealthyKidneyStore.com to use and disclose any of my health information, including all individually identifiable health information obtained through bonus email customer support communications with our staff of health coaches, as well as any other pertinent documents, forms and/or telephone communications for the purpose of treatment, payment and health care operations. This authorization additionally includes, but is not limited to, any health information relating to HIV and other sexually transmitted diseases, mental health or disease, drug or alcohol treatments.

HealthyKidneyStore.com ’s privacy notice provides more detailed information about our privacy policies, and you are encouraged to review it before agreeing to this authorization.

I declare under penalty of perjury that the foregoing is true and correct. My agreement to this statement constitutes my signature.