Amazing Kitchari 
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Kitchari Cleanse &/or NHM Informed Consent 

All material provided from Kitchari Cleanse - Shasta Tierra is provided for information or educational purposes only.  You may schedule a private consultation with Shasta Tierra L.Ac or with your physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.  The advice and instructs presented from Kitchari Cleanse - Shasta Tierra L.Ac., are in no way intended as medical advice or as a substitute for medical counseling. The informant is meant and should be used with the guidance and care of your physician.

We advise you to consult your physician before beginning this program as you would any detox, weight management or weight loss program.  Make sure your physician is aware of all medical conditions that you may have as well as the medications and supplements you are taking.

If you are on diuretics or are diabetic and on medication for these or have gallbladder or liver disease or take any medications, you should proceed only under a doctor's supervision.  As with any plan, the weight loss phases of this nutritional plan should not be used by pregnant or nursing women, or patients on dialysis.

Participants must be 18 years or old to participate in the Kitchari Cleanse.

The Kitchari Cleanse is a unique one week, three week or six week nutritional and self care program designed to detoxify the body while strengthening the  "digestive fire" for optimal health and healing.

I understand that herbal and nutritional supplements and nutritional advice recommended to me by Shasta Tierra generally are safe in the recommended doses. Large doses of herbs taken without Shasta Tierra's recommendation may be toxic, and some herbs are inappropriate during pregnancy. I will let Shasta know if I am pregnant or am trying to become pregnant. Some possible side effects of herbs are nausea, gas, stomachache, vomiting, headache, diarrhea, rashes, hives and tingling of the tongue. I understand that l must stop taking any herbs and notify Shasta Tierra as soon as I experience any discomfort or adverse reactions.

I understand that all of my health information will be kept confidential unless approved otherwise.

I understand that I can discuss risks and benefits further with Shasta before signing if I so choose. However, I do not expect Shasta to be able to anticipate and explain all possible risks and complications of treatment. I rely on Shasta to exercise his or her judgement in my best interest during the course of treatment, based upon the facts then known.

I understand that there will not be any refunds and that all sales are final.

I understand that doing the kitchari cleanse is in no way a guarantee of weight loss or a treatment or cure for any condition. I have been informed to consult with my physician before proceeding with this program. In choosing to proceed with the kitchari cleanse program I am doing so with the above full knowledge and consent. In signing this form I acknowledge any inherent risks and give my consent.

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