Below is the Questionnaire that will need to be completed. Please send me an e-mail at Support@RegenerateNaturallyNow.com and I will send you this form as well as the two others to be completed and emailed back to me...     

I fully understand that the Registered Holistic Practitioner, Ronnie Davis, C.T.N.
is not a Medical Doctor and not a Psychologist.I also Understand that Diagnosis
or Treatment for any Disease or health condition is beyond the scope of any Registered Holistic Health Practitioner.If you have any disease,health problem or health condition you are now being advised to seek qualified medical advise from
a licensed physician !  (C.T.N.)= Certified Traditional Naturopath by the A.N.M.A
I am here as a Nutritional Client,on this visit through internet online or personal
visit. I am not an Agent for Federal,State or Local Agencies on a Mission of Entrapment,or for any Investigative purposes. I also acknowledge that under the Bivens Act,Article 42, I will be held personally and individually liable for any cost to Regeneration,Inc. / Ronnie Davis, C.T.N. that may result from my visit.
Please note that honesty prevails as we respect and educate all of our clients.
 
I understand that the above named practitioner,teaches clients how to build their own health through training in the use of Life-Style Modification,pollution avoidance ,clean air,pure water,proper foods,rest,exercise,meditation,goal orientation,positive mental attitude,stress reduction techniques,while assisting with spiritual and physical factors that can affect one's overall health.
 
I realizethat services provided may or maynot include examination of saliva, hair samples,urine,dietary practices,etc.,for energy / stamina evaluations.Any Evaluation Test is Not Medical in nature and such tests are not procedures for Diagnosing or Treatment of Any Health Condition or Disease. I am now being informed today that such Evaluation Testing is Not Approved by any branch of the Medical Profession and is Not Approved by the Food And Drug Administration.
 
Recommendations,suggestions, and references to Meals,menus, or Nutritional Supplements are for body building, increased stamina, and energy,general health maintenance and do Not involve Any Diagnosing, prognosticating, or Prescribing for theTreatment of Any Diease or health condition.
 
I hereby request the services of Ronnie Davis,C.T.N. / Regeneration Natural Health Institute,Inc., in good faith exercising my free will to Contract for what I believe is most beneficial for me. I am not obligated to continue utilizing the services of Ronnie Davis,C.T.N. and i may discontinue the services at any time.My Contract for services is not to be overridden by any family member, court of law,medical facility or physician.
 
My signature below states that I agree to retain the above named Registered Holistic Health Practitioner.
 
 
Print Name:_______________________________________________________
 
 
Signature:_________________________________________________________
 
 
Date:_____________________________________________________________