I warrant that I have read the Vital-Side LLC’s (“Vital-Side”) Terms of Use Agreement and Privacy Policy, and in accordance with such agreements, understand and voluntarily agree that:

  • I will keep (and be on time for) all my scheduled appointments with the Vital-Side team.
  • If I need to schedule or reschedule an appointment, I will give 24 hours’ notice. If I don’t give 24 hours’ notice before rescheduling, I am aware that there may be a late rescheduling fee. Vital-Side does not offer refunds for cancellations.
  • I will keep up to date with any payments, and I will not call or attend an appointment unless I have paid the amount necessary for services provided in full before our scheduled appointment.
  • I understand that Vital-Side is in no way a medical treatment program. Any results, information, or suggestions given will not be considered medical treatment in any way, and I agree that I will:
    • Communicate with my existing medical practitioner before and while engaging in Vital-Side services and continue any existing treatments prescribed to me;
    • Inform Vital-Side and my existing medical practitioners if my condition is exacerbated or worsened by any information provided by Vital-Side, seek emergency care as appropriate, and terminate Vital-Side services as necessary;
    • Let Vital-Side know if there are conditions that may prevent me from excelling in the program;
    • Disclose to Vital-Side any of my symptoms that could be harmful to myself or others; and
    • Assume all risks associated with engaging in Vital-Side services and not hold Vital-Side liable for side effects of Vital-Side’s services.
  • I am aware that Vital-Side is an experiential program. Information provided is for informational purposes only and represents the opinions formed by Vital-Side members based on experiences, the experience of others, and research of sources.
  • I will do my best to be open-minded about all new information learned in the program.
  • While there are no guaranteed results from using Vital-Side services, I understand that it is recommended that I commit a minimum of six months to healing my limbic system.
  • I will not sell or distribute learned information, handouts, packets, or any other materials from Vital-Side to others. I understand that if I do, my participation in the program will be stopped, and Vital-Side reserves the right to seek all remedies under the law.
  • I will treat the staff at Vital-Side and shared offices and any other members of group services or group forums respectfully. I understand that if I am disrespectful or disrupt others' care, my participation in the program will be terminated.
  • I understand that any information I give to Vital-Side is voluntary information and that although Vital-Side will keep information shared in one-on-one sessions confidential, anything shared in group services will not be treated as confidential. Further, I understand that Vital-Side’s services do not fall under the Health Insurance Portability and Accountability Act (HIPAA).
  • I understand that I may lose my right to participate in Vital-Side services, without refund, if I break any of the terms found in Vital-Sides Terms of Use Agreement or Privacy Policy.

Name: ________________________________________

Signature: _____________________________________                                              Date: ______________

I have read and understand Vital-Side’s Terms of Use Agreement and Privacy Policy: YES / NO