Client Disclosure, Consent & Waiver Agreement
Qest4 Bioenergetic Wellness Consultation • Herbal & Naturopathic Support Services. Please read each section carefully, initial every item, choose your AI-report preference, and sign at the bottom. All items must be completed before your questionnaire can be submitted.
Trevor's Love, Inc. walks alongside each client as nature's assistant in the body's own ability to heal. Before beginning any consultation, service, or Qest4 bioenergetic evaluation, please read, initial, and sign this Agreement in full. This document combines our general Disclosure & Waiver, our Qest4 Clinical Appraisal consent, and our AI-assisted reporting preference into one complete record.
Section 1 — Disclosure and Acknowledgment
While the undersigned participant ("Participant") is engaging with any practitioner, employee, contractor, or agent at or associated with Trevor's Love, Inc. (collectively referenced "Practitioners") and while such Practitioners are providing certain services, including, but not limited to, massage therapy, herbal solutions, or any such other naturopathic therapies, the Participant understands and acknowledges that Participant is NOT consulting with a licensed medical professional in any capacity and is NOT being advised as to any form of medical diagnosis, treatment, or other activities typically undertaken by a licensed physician.
Regardless of the tasks, conversations, consultations, or other interactions undertaken by the Participant, the Participant recognizes and agrees that individualized recommendations are offered and provided by such Practitioners as an educational and informative consultation only. Participant recognizes that any action taken by Participant because of any such consultation, therapy, or other service is done at the sole discretion of the Participant. Participant further understands that it is strongly recommended that Participant maintain a relationship with one or more licensed physicians qualified to care for bodily or mental health condition(s) and that Participant communicate with such licensed physician(s) regarding any services or action taken in conjunction with a consultation or service provided by any Practitioner.
Section 2 — Release of Liability
In exchange for the fee paid, Practitioner is providing a service, consult, or other program to assist Participant with whole body wellness through the use of massage therapy, various herbal solutions, and other naturopathic therapies. Therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Participant knowingly and willingly fully waives, releases, and discharges any and all claims the undersigned Participant might have or may have in the future, against any Practitioner, or Trevor's Love, Inc, its officers, directors, members, agents, contractors, independent contractors, attorneys, and employees, which might or could arise from the Participant engaging in the services provided by any Practitioner and as generally referenced herein.
By agreeing to or signing this Disclosure, Waiver and Release of Liability, Participant agrees that neither Trevor's Love, Inc. or any of its Practitioners shall be responsible for any negative consequence of any kind which is claimed to result from: 1) Participant's engagement in any of Trevor's Love, Inc.'s activities or consultations; or 2) from the use of any information learned or obtained during such programs, activities or consultations, including, but not limited to, the integration and use of herbal medicine, massage therapy, or any other naturopathic therapy.
More specifically, Participant acknowledges and agrees to the following. Please initial each item:
Participant understands and acknowledges that Practitioners are NOT medical physicians, nor do such Practitioners engage in standard medical assessment, diagnosis or treatment. In any activity the Participant engages in while interacting with such Practitioners, the Participant acknowledges and agrees that he/she seeks this information only for health-related matters, and strictly for educational purposes. Participant understands that information received in the course of any interaction with the Practitioners should not be interpreted as the advice of a licensed medical professional. The undersigned Participant acknowledges that if such Participant chooses to use any of the information provided in the course of Participant's interactions with the Company, that such Participant will first consult with Participant's physician before pursuing any form of treatment and in engaging in the programs, or private consultation with Practitioners. Participant recognizes that it is Participant's sole responsibility to notify the Practitioner ahead of time, both verbally at the time of any such service and in writing, of any pre-existing medical conditions or injuries or if any discomfort should arise during any such service. Participant understands that the Practitioners do not claim to offer advice about the use of any type of pharmaceuticals or medications and that the information obtained via consult with any such Practitioner is meant for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Participant is fully aware of the potential risks and dangers associated with utilizing dietary, nutritional, homeopathic, naturopathic therapies, and other natural or alternative forms of medicine as a substitute for the advice and treatment administered by a licensed physician, and Participant hereby releases, waives, and discharges Trevor's Love, Inc., its officers, directors, shareholders, members, agents, contractors, independent contractors, attorneys, and employees from any claim based on the Participant's use of such the same. Participant fully understands, appreciates, and accepts the risks and dangers of utilizing dietary, nutritional, homeopathic, and other natural or alternative forms of medicine as a substitute for the advice and treatment administered by a licensed physician, and Participant voluntarily chooses to interact with and engage in the discussion of alternative health remedies with Trevor's Love, Inc. and its Practitioners. Participant has the right to have this Disclosure, Waiver, and Release of Liability reviewed by Participant's lawyer and by initialing here and signing below Participant acknowledges he/she has done so or has decided not to do so.
By signing this informed consent, the Participant agrees to forever release Trevor's Love, Inc., its officers, directors, shareholders, members, agents, contractors, independent contractors, attorneys, and employees from any and all actions, claims or demands that Participant, Participant's heirs, next of kin, spouse and legal representatives now have, or may have in the future related to Participant's engagement in any of the services offered by Trevor's Love, Inc. or its Practitioners. Participant agrees to be responsible for all legal costs and fees that may result from action(s) on Participant's part or on the part of Participant's representative(s) against Trevor's Love, Inc. or any Practitioner. Participant agrees that any dispute or matter shall be judged by the standards and principles of complementary, alternative, naturopathic therapies, and/or holistic medicine and not the standards and principles of conventional medicine.
This Disclosure, Waiver, and Release of Liability shall be interpreted, enforced and governed in all respects by Florida law. In the event of any dispute, controversy, or claim arising out of or related to this agreement, including the validity of this mediation clause, the parties agree to participate in at least four (4) hours of mediation. The parties agree to select a mutually acceptable mediator in Manatee County, Florida. The parties shall share the mediator's fee and any filing fees equally. The mediation shall be held in a place mutually acceptable to the parties in Manatee County, Florida.
Should any provision of this agreement be held by a court or arbitral authority of competent jurisdiction to be enforceable only if modified, or if any portion of this agreement shall be held to be unenforceable and thus stricken, such holding shall not affect the validity of any other provision of this agreement, the balance of which shall continue to be binding on the parties with any such modification to become a part hereof and treated as though originally set forth in this agreement.
Waiver of Jury Trial. Participant hereby waives its right to a jury trial of any claim or cause of action based upon or arising out of this Disclosure, Waiver, and Release of Liability. The scope of this waiver is intended to be all-encompassing of any and all disputes that may be filed in any court and that relate to the subject matter of this Disclosure, Waiver, and Release of Liability, including, without limitation, contract claims, tort claims (including negligence), breach of duty claims, and all other common law and statutory claims.
Participant's signature verifies that Participant has not been told to discontinue treatments with any other medical specialists or other health care providers. Participant's signature is being given prior to rendering any service, advice, and/or recommendations whatsoever.
Section 3 — Qest4 Clinical Appraisal Disclosure & Consent
Restricted for Professional Use Only. The QEST4 system provides a completely non-invasive method for gaining valuable information about an individual's Innate Intelligence and/or energetic field. The primary objective of the evaluation is to disclose energetic imbalances and provide feedback that will assist in developing a program to support each physical and energetic system of the body.
Please initial each item:
I understand that I am here to learn about natural health and better lifestyle practices, and I will be offered information about food, supplements, and herbs as a guide to supporting my well-being. I understand that I should continue to see any physicians I may be currently under the care of and that any prescribed medications should not be altered without first consulting the physician who prescribed them. I fully understand that those who counsel me may not be licensed physicians. I am not seeking any medical diagnosis or medical treatment in relation to the QEST4 evaluation. I fully understand that information about traditional uses of supplementation that may support balance may be discussed. I fully understand that this information is not intended to be interpreted or used as a substitute for medical care offered by a licensed physician. I fully understand that anything said, done, typed, printed, or presented in any other fashion to me is not intended to diagnose, prescribe, treat, or take the place of a licensed physician. I fully understand that the intent is to provide educational information for the purpose of assisting me with the lifestyle changes necessary to regain and maintain an environment needed to support a well-balanced lifestyle. I am not on this visit, or any subsequent visit, acting as an agent for the federal, state, county, local law enforcement, or news media on a mission of entrapment or investigation. I understand that all information and conversations will be kept confidential, and that information concerning myself may only be released to a health professional with my written consent. I understand that the QEST4 evaluation will only identify energetic imbalances and does not diagnose any diseases. The Balancing Item refers to the energetic signatures needed to restore balance to body's energetic field. Balancing Items are defined differently from physician terms and are not a cure for any disease. I recognize that the QEST4 evaluation is an unorthodox approach to supporting my well-being. Being of sound mind, of my own free will and in exercise of my constitutional right for the attainment of life, liberty and the pursuit of happiness, I have chosen this evaluation method to assist in balancing my health. I understand that the QEST4 evaluation does not provide a medical diagnosis and that my testing technician may recommend further medical care and testing. If I suspect I need medical intervention, I understand I should consult MY physician. I give my permission for the testing technician to evaluate me with the QEST4. I understand in doing so, my testing technician is NOT becoming my primary physician. I understand that the testing technician will give me information about my body's energetic field and make recommendations based on the QEST4 evaluation. I understand that the testing technician will not pass judgments on prescribed medications and it is the responsibility of my primary physician to make any adjustments to prescribed medications or methods of treatment. Any decision to follow through with the recommended protocol is my own decision and I will not hold the testing technician liable.
Section 4 — AI-Assisted Report Preference
Trevor's Love, Inc. may use AI-assisted technology, under the guidance and review of your practitioner, to help organize Qest4 scan findings into a personalized written wellness report. This tool never replaces your practitioner's discernment — it simply helps translate energetic scan data into a clear, readable narrative for your understanding and encouragement.
Your privacy is protected: no personal identifying information — including your name, email address, phone number, date of birth, or any other identifying detail — is ever entered into or shared with the AI tool. Only your anonymized scan findings are used to help generate the report narrative.
Please note: if you opt OUT of AI-assisted reporting, you will still receive your Qest4 results and recommended protocol — however, your report will be more general and summarized, and will not include the same level of detailed, personalized narrative breakdown that AI-assisted reports provide.
Please choose one:
I OPT IN to AI-assisted reporting I OPT OUT of AI-assisted reporting
I confirm that the AI-reporting preference marked above is my own informed choice, and I may update this preference at any time in writing with Trevor's Love, Inc.
I, the undersigned Participant, acknowledge that I have read and understood the contents of this Disclosure, Waiver, Qest4 Consent, and AI-Assisted Reporting Preference, and hereby agree to the same. Type your full name to sign
Typing your name above and checking the box acts as your electronic signature. Today's date will be recorded automatically.
Please initial every item in Sections 1–3, choose your AI-report preference and confirm it, type your name, and check the agreement box before submitting.
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