Disclaimer and Consent Through Purchase: The herbs and nutritional supplements (which are from plant, animal, and mineral sources) that have been recommended are traditionally considered safe in the practice of Chinese Medicine, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomach ache, vomiting, headache, diarrhea, rashes, hives, and tingling of the tongue. I understand the results are not guaranteed. All herbal formula prescriptions are NON- REFUNDABLE.
I HERBY RELEASE and FOREVER DISCHARGE and agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS Dr. Xin Tong and the Derun Clinic LLC, ("Doctor"),144 South Federal Highway, Boca Raton, FL, 33432, including its officers, directors, employees, staff, assigns and legal representatives from any and all liability, claims, losses, costs, expenses (including without limitation, attorney fees) or demands (except those arising from the gross negligence or willful misconduct of the aforementioned party) I, my heirs, executors, trustees, administrators, assignees, distributes, personal or legal representatives and all members of my family, may now have or in the future make against DOCTORS as a result of or related to any injury, loss, death or damage of any kind whatsoever resulting from the PATIENT's participation in the DOCTOR’s program of medical care and treatment, or from any mishap that may occur during the time under direct or indirect supervision from DOCTOR, or his office staff, or other directed health care partner(s).
I HERBY RELEASE and FOREVER DISCHARGE and agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS Dr. Xin Tong and the Derun Clinic LLC, ("Doctor"),144 South Federal Highway, Boca Raton, FL, 33432, including its officers, directors, employees, staff, assigns and legal representatives from any and all liability, claims, losses, costs, expenses (including without limitation, attorney fees) or demands (except those arising from the gross negligence or willful misconduct of the aforementioned party) I, my heirs, executors, trustees, administrators, assignees, distributes, personal or legal representatives and all members of my family, may now have or in the future make against DOCTORS as a result of or related to any injury, loss, death or damage of any kind whatsoever resulting from the PATIENT's participation in the DOCTOR’s program of medical care and treatment, or from any mishap that may occur during the time under direct or indirect supervision from DOCTOR, or his office staff, or other directed health care partner(s).