Patient Agreement for Homoeopathic Medical Treatment

Consent for Homoeopathic Medical Treatment
I voluntarily consent to medical treatment provided by Premilife and associated homoeopathic physicians, clinicians and other personnel. I am aware that the practice of medicine (be it in homoeopathy or western medicine) is not an exact science and I acknowledge that no guarantees have been made as to the result of any treatment.

Agreement of Patient Responsibilities
I covenant and agree to comply with the methods of instruction, treatment and dosage schedules prescribed by Premilife and/or each of the other physicians and health care professionals from whom I seek treatment. I further acknowledge and agree that Premilife is not liable for any of my negligent acts or omissions in connection with the homeopathic treatments that I receive from Premilife, including without limitation, failing to following treatment protocol and directions.

Acknowledgement of Risks
I fully understand there are risks associated with taking homeopathic remedies and treatments, including without limitation, the possible aggravation of symptoms which existed prior to use of such treatments as well as new symptoms and side effects that never existed previously.  Should I experience any problems, which I associate (directly or indirectly) with the treatments supplied to me by Premilife, I will immediately suspend taking those treatments and I call my physician or health are professional.

Premilife Fee
I acknowledge that full payment for each Premilife treatment must occur before my order will be shipped.  Accordingly, all payments are due at the time an order is placed with Premilife, together with applicable shipping and handling costs.  Payments may be made by wire or credit card.  I acknowledge that my Premilife treatments are not covered by my insurance plan, and therefore, are my entire financial responsibility. All payments are non-refundable, except if a shipment should fail to arrive.  Premilife does not offer refunds on homoeopathic treatments (whether unsealed or sealed).

Confidential Information
Applicable privacy laws and regulations protect the privacy of all communications between a patient and a physician. In most situations, Premilife may only release health information about my treatment to third parties if I sign a written authorization form that meets certain legal requirements imposed by the United Kingdom Data Protection Act of 1998.  There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities. Premilife may occasionally find it helpful to consult other health professionals about a case. Premilife will always secure your consent before doing so. You should be aware that Premilife employs administrative staff and shares protected information with these individuals for administrative purposes, such as billing, shipping and quality assurance. All staff members have been given training about protecting your privacy and have obviously agreed not to release any without proper authorization to do so.

If you are under 18 years of age and not emancipated, you will require the written consent of a parent or guardian before placing an order of any kind with Premilife.

Binding Legal Obligation
I understand and acknowledge that I am solely responsible for seeking, receiving/taking and paying for any and all homeopathic treatments supplied to me by Premilife. By signing below, I acknowledge that this binding legal agreement has been read in full and explained to me by an authorized Premilife representative, if I’ve made such a request in writing of Premilife.

Choice of Law; Venue
This Agreement shall be governed by the laws of the State of Israel.  Any disputes arising under this Agreement shall be exclusively adjudicated in the State of Israel.

The undersigned, by signing below, hereby confirms that: he/she is the parent/legal guardian of the minor referenced above; he/she agrees to the terms and conditions set forth in this Agreement on behalf of the aforementioned minor; and he/she is legally authorized to enter into this agreement on such minor’s behalf.

Premilife is advised by leading legal and accounting professionals worldwide, including Greenberg Traurig LP (


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