I hereby authorize Kanakaveda Homeopathy and whomever he designates as his / her assistant to help me in my treatment / weight loss reduction effects and my coexisting medical condition. I understand that my program consists of a balanced diet, a regular walking program, instruction in behavior modification techniques and use of Homeopathic Medicines. I understand that Homoeopathic Medicine doesn’t have side effects.

I understand that remaining overweight or obese puts me at greater risk for High blood pressure, diabetes, Arthritis of the joints esp. weight bearing joints, such as hips, knees, feet, back. High cholesterol and Triglycerides, vascular disease complicated by stroke, heart attack, abnormal heart rhythms, Cancer, gall stones, sleep apnea and sudden death. I understand that risks may be modest if I am not significantly overweight, but will increase with additional weight gain. I understand that success of the program will depend on my efforts and that there are no guarantees or assurances that the program will be successful. I also understand that Obesity may be chronic, lifelong condition, that may required changes in eating habits and permanent changes in behavior to be treated successfully. I also understand that I will have to check my weight regularly.

(For Woman) I understand that weight loss program should not take during pregnancy. This has been explained to me fully. To the best of my knowledge, I am not pregnant, I am aware of the precautions that should be taken to avoid pregnancy. If I become pregnant I will inform to doctor in writing.

I understand that following causes are responsible for weight gain.

• Behavioral factor :High fat diet, impulsive over eating, sweet, Alcohol consumption, sudden smoking cessation.
• Genetic Factors :Familial tendency, Prader wills syndrome, and others.
• Medication :Tricyclic antidepressant, sulphonyl urea drugs; O.C.P., corticosteroid. Hormonal Treatment and others.
• Endocrine disorders :Hypothyroidism, Cushing syndrome, Insulinoma, Hypothalamic Tumors, or Injury, P.C.O.D. and others.
• Others causes :Post pregnancy, eating disorder, menopause, sitting job, loss of physical exercise

NoteTill the treatment is fully complete the patient should consult online or come weekly for follow up.

• Once the fees paid will not be transfer or given back. Patient have to complete the Program in valid Period.
• If patient is taking allopathic treatment for any illness, He/ She should first consult to his/ her concurred Dr. to stop the medication or reduce the dose of medicine. Pt. should not stop medication by his / her own.
• I’m aware, to give permission to Kanakaveda can use my before and after photos or videos for any publication / research and presentation for betterment of Society.
• I’m aware that I can’t take other Ayurvedic or Homeopathy treatment while taking this treatment.

PRECQUSTION TO BE TAKEN

Homeopathic medicine should be taking sublingually, while taking medicine does not take anything 20 minutes before or after.

Avoid: Onion, Garlic, Ginger, Coffee, Alcohol, Tobacco, Smoking, Potato, Spices, Cold-drinks, strong perfumes, Non-veg, Ice-cream, Bakery product. I understand that result of weight loss vary from patient to patient success of weight loss depends on my commitment and sincerity.

I have read and fully understand this consent form and I realize, I should not sign this from if all items have not been explained to me or my questions have not been answered to my complete satisfaction. I have been urged to take all the time I need in understanding this form. I’m agree with all terms and conditions mentioned above.