MEDICARE CONSULTATION ~ DISCLOSURE AND WAIVER OF LIABILITY AGREEMENT

DISCLOSURE AND WAIVER OF LIABILITY AGREEMENT

For: Leta Blank Medicare Consulting

I, the (“Client”), acknowledge that by receiving  my appointment confirmation email that I agree to and understand the contents of this liability agreement.

1. LETA BLANK makes no representations, claims, or guarantees regarding the efficacy of her recommendations. The recommendations are based upon a combination of her education, knowledge and experience. A consultation as provided by Leta Blank does not constitute a guarantee in any way.
2. Individualized recommendations are offered and applied as an educational and informative consultation. Any action taken as a result of the consultation is done at the sole discretion and risk of Client.
3. Client understands and has been made aware of this at the time of scheduling their appointment and prior to rendering any service, advice, and/or recommendations whatsoever.
4. Financial Policy: Patients are fully responsible for all professional services received. Charges to be paid in full in advance of any appointment made out directly to Leta Blank. There is a twenty-four-hour cancellation policy in effect with no exceptions. There us no refund or credit toward a new appointment.

The user certifies that he or she has read the entire agreement and that he or she understands the entire agreement. The user affirms that he or she is accepting the agreement with the full intent of releasing Ms Blank from liability for loss due to the user’s reliance on any information obtained from Ms Blank.