Schedule Appointment with Two Purple Carrots

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Membership- Lisa/Alex	x $299.00	$299.00 per month
Total: $299.00	Coupon:

I understand that the entire clinic of "Two Purple Carrots" including Lauren Keller, Lisa Cipkar and Alex Bucko are not medical doctors and do not treat or diagnose illness of any kind. The clinic only serves to provide clients with knowledge of how to navigate the healthcare system as well as helping clients find their own paths to healing through detoxification and lifestyle changes.

If you believe you have a serious medical condition that requires immediate medical attention, please seek a medical provider immediately. You also agree that "Two Purple Carrots" and Lauren Keller will not be held liable for failure to diagnose or treat an illness, nor will she be liable for failure to prevent future illness.

Please note that you are responsible for consulting with your medical doctor before starting a new treatment plan. Additionally, I promise to give two Purple Carrots a complete and accurate account of any medical conditions before engaging in mentorship with her.

I have volunteered to participate in chronic illness mentorship under the direction of "Two Purple Carrots" which will include but is not limited to nutrition, detoxification methods, elimination diets, supplement use, reducing EMF exposure, better sleep hygiene, meditation practices and personalized support and encouragement.

I hereby forever release and discharge and hereby hold harmless "Two Purple Carrots" and Lauren Keller from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in any chronic illness mentorship including any injuries resulting from. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand the results are individual and may vary.

Please note the cancellation policy is as follows: if you do not cancel within 48 hours of your appointment time, you will forfeit the money paid for that appointment time. Please always cancel or change your appointment before the 48 hour time line. This allows Two Purple Carrots to fill that spot with individuals on the waiting list.

Please also note that no refunds are given at anytime after a session has occurred.

By checking that you have read and agree to the terms above, you agree to all of the above and recognize that all parties of Two Purple Carrots and Lauren Keller, MA, MSN, CNM are not acting as medical professionals.