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Welcome to Harvest

Health Alternatives LLC!

We're excited to offer innovative natural solutions for your wellness!

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Holistic healing and energy balance without the needles.

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HARVEST HEALTH ALTERNATIVES LLC

307-670-9014

439 Prairieview Drive, Ste. A

Gillette, WY, USA

CHECK OUT ALL THE INFORMATION AVAILABLE ON THE FACEBOOK PAGE

Christian Booklet

CONSENT to participate RHS - REMOTE HEALTH SERVICES

First name*

Last name*

Email*

choose your country & list phone # *

AGE*

Month

Day

Year

Physical Address - town - state*

Please list all Recent diagnosis, surgeries AND list all prescriptions currently taken and any supplements that you take regularly. *ALSO Please describe your reason for a visit. Explain condition, symptoms associated and or history pertaining to visit.*

TYPE THE WORD "CONSENT" IN THE BOX BELOW WITH YOUR INITIALS. *Example: Consent - JDC*

*You must type the word "CONSENT" in the box above - AND include your initials next it - this allows you to participate & protect you while participating in RHS Therapy, distant sessions - this affirms you are giving electronic consent for the treatment of QE-RHS (Quantum Entanglement/Remote Health Services)

SUBMIT ANY RELEVANT INFORMATION YOU WOULD LIKE TO PROVIDE - attach any current (3-6 months) lab-work or test results here

RHS - REMOTE HEALTH SERVICES QUESTIONS & CONSENT - Please check any box that applies to you - the answer of the following is to better serve you.*

Have you ever been seen by a Naturopath Doctor or Practitioner or Holistic Practitioner?

Have you ever had Frequency treatments? such as Rife, PEMF, Scalar or QE therapy (quantum entanglement)

I am Aware of & know what Quantum Entanglement entails

I have no limitations from my doctor relating to the use of electro-therapy type treatments. Ex: tens machine, ultrasound, frequency type devices etc.

I DO NOT have a pacemaker or internal heart defib.

I am providing DNA for QE Therapy & I know that there is no opportunity for risk.

MUST CHECK THIS BOX TO PARTICIPATE. I consent fully & waive all rights to arbitrary. I will abstain from any form of libel regarding this treatment and or the practices/choices for treatment from Harvest Health Alternatives. I have not been coerced to answer or check these boxes for my consent & I WILL NOT CHECK THIS BOX IF I BELIEVE I HAVE BEEN COERCED.

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