Ideal protein is a medically supervised program and you must be prequalified to be on the program.
Step 1: Please read below and digitally sign
The following disqualifies you from being on Ideal Protein:
Vegan Lifestyle – Strict vegans do not qualify due to too many dietary restrictions
Type I Insulin-dependent (insulin injections only)
History of Congestive Heart Failure
Any type of Heart Surgery
Pregnant
Breastfeeding
Bipolar Disorder
Parkinson’s Disease
Alzheimer’s Disease
The Following May Need Medical Doctor written consent:
· Blood Clot (or history of)
· Pulmonary Embolism (or history of)
· Stroke or TIA (or history of)
· Coronary Artery Disease (or history of)
· Heart Valve Problem (or history of)
· Heart Valve Replacement (porcine/mechanical)
· Arrhythmia and on medications
· Hypertension (high blood pressure)
· Hypokalemia (low potassium)
· Hyperkalemia (high potassium)
· Kidney Transplant
· Kidney Disease (or history of)
· Liver issues/disease (or history of)
· Gastric Ulcer
· History of Bariatric Surgery
· Epilepsy
NPC (Medical Doctor Ideal Protein Supervision needed)::
· Heart Attack (history of)
· Congestive Heart Failure (current)
· Cancer (or history of)
· Cancer Remission
Confirmation of full health status disclosure by the client and agreement to arbitrate disputes
I confirm that the information that I have provided and that is recorded by me on the “Ideal Protein" Health Profile is true, complete and accurate and that I have not withheld or otherwise omitted, whether in whole or in part, any information concerning my health status. In this respect, I confirm that I have disclosed all past and present i) physical and/or mental health problems or concerns that I have experienced, ii) diagnoses and/or surgeries that I have had, and iii) medications and supplements that were prescribed to me or that I have taken.
Without limitation to the foregoing, I specifically confirm that I do not have any of the conditions and that I am not taking any of the medications specifically discussed on intake forms in drkwik.com. Furthermore, I understand that I should not be undertaking or otherwise following the “Ideal Protein" Weight Loss Method if I have any of the said conditions or if I am currently taking any of the said medications unless i) I specifically consult with a medical doctor concerning my suitability to go on the “Ideal Protein" Weight Loss Method, ii) remain under the supervision of said medical doctor while I am on the “Ideal Protein" Weight Loss Method, and iii) provide documentation confirming the foregoing.
I understand that if i) I have any of the aforementioned conditions or if I am currently taking any of the aforementioned medication, ii) have not disclosed same to the clinic and iii) nevertheless chose to go on the “Ideal Protein" Weight Loss Method without specific supervision, such decision will be completely voluntary, and I release and discharge the clinic as well as Ideal Protein of America, its parent companies, subsidiaries and affiliates and their respective shareholders, directors, employees, agents, representatives, successors and assigns (collectively, the "Releases") from any and all damages, liability, claims and causes of action of any nature whatsoever (including for injury, illness or death) that may result from such voluntary and informed decision
I confirm that the “Ideal Protein" Weight Loss Method has been explained to me, that I have had the opportunity to ask questions relating to the “Ideal Protein" Weight Loss Method, that I have been provided with the answers to such questions and that I understand the importance of strictly following the “Ideal Protein" Weight Loss Method as explained to me verbally and in the materials provided to me, both before and during the period I will be following the “Ideal Protein" Weight Loss Method.
Without limitation to the foregoing, I confirm that I have been advised that because the “Ideal Protein" Weight Loss Method limits the ingestion of certain foods, it is important that I consume the recommended vitamins and minerals while I am on the “Ideal Protein" Weight Loss Method.
I undertake to disclose immediately to the clinic any and all changes in my health status, discomfort, symptoms or other health concerns that I may experience while I am on the “Ideal Protein" Weight Loss Method.
I specifically agree that all claims against any of the Releases that I may have or choose to make shall only be submitted to binding arbitration under the rules of the Arbitration Act or similar statute of my province of residence, and I waive any rights to pursue any claims or causes of action in any court of law.
