Powering Forward Boot Camp Disclaimer
By participating in this Health History Questionnaire, the participant ("you") are acknowledging that you will be providing or have provided information that may be collected, stored, reviewed and disclosed to others. You hereby permit such disclosures and waive all rights under HIPAA and all other disclosure laws for private information, if any for federal and state purposes. You may revoke this disclosure at any time by providing written notice to the program sponsor.
You also acknowledge that the information collected will not be used to diagnose, treat, warn, consult or otherwise assist you in any medical, health or other manner and you therefore release and hold harmless all persons, organizations and entities, their agents, attorneys, assigns, subsidiaries and all others as it relates to your medical and health conditions, whether known or unknown now or in the future. The collection of data in this questionnaire is for research and study purposes only and shall not be used as a substitute for appropriate medical care. YOU SHOULD ALWAYS SEEK THE GUIDANCE OF YOUR MEDICAL DOCTOR OR DOCTORS. The program employees, managers, proprietors, and all others connected with the program are not your medical doctors or providers and you acknowledge that you are not seeking medical care, treatment, guidance, advice or information from them to assist you with your medical or other health condition(s), if any. You agree to these terms and if you do not, then please do not participate in the program.