Customer Information Form
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Disclaimer & Diagnosis Verification​
The information provided on this website is for educational and informational purposes only and does not constitute medical, advice. We do not guarantee any specific therapeutic outcomes or results. Users assume full responsibility for any actions taken based on the content of this website and are encouraged to consult a qualified professional before making decisions related to health or wellness. We are not liable for any risks, damages, or adverse effects resulting from the use of this website.
By completing this form, you affirm that you are 18 years of age or older, have not been diagnosed
with Bipolar 1 disorder, Schizophrenia, experienced manic episodes or are on Lithium.