I understand that the HCG Diet is designed for individuals who are in an acceptable physical condition that meets the HCG diet requirements. I verify that I am in acceptable physical and mental health and that I have discussed the HCG Diet with my physician and that he/she has given me permission to proceed with the HCG diet as outlined. I understand that I will be working with an HCG weight loss consultant who is not a medical doctor and does not treat any medical condition(s).

I understand that though it is not likely, it is possible to experience minor side effects. I understand that should I experience any unusual, unexplainable or unexpected symptoms, I will discontinue the program immediately and contact LifeStyle Wellness Center, LLC.

I understand that I will not be able to start the HCG Diet until after I have completed an initial consultation which will take approximately 1 hour and has a minimal consultation fee of $15.00

I understand that I will need to purchase some recommended supplements and there is a 15% restocking fee for returned unopened products within 7 days. I understand that I am liable to pay the shipping fees on returned products.  I understand that I am responsible for any allergic reaction that may occur as a result of undisclosed allergies.

By my signature, I certify that I am at least 18 years of age, I acknowledge that I have read and understand the above, have not been coerced in any way, I was made no promises about weight loss amounts, and do state that I want to participate in the HCG Diet with LifeStyle Wellness Center with this understanding.

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