Blood Type Diet Information Form


Please complete the form below prior to your appointment. All information is kept strictly confidential. Thank you.

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I understand that each blood-type prescription shows how, according to my blood-type, I should adapt my lifestyle, deal with stress, and put into practice the right strategies for aging, to achieve emotional balance, maximize my health, and overcome disease. I further understand that my participation in the Blood Type Diet Program should not be construed as a substitute for a medical examination, diagnosis or treatment, and I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment I am aware of. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile, and I understand there shall be no liability on the practitioners’ part should I forget to do so.


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