Frozen Fraud Delivery Services informs us:
http://www.deltamemberservices.com/sites/default/files/samples/Research%20Center%20%28Outpatient%29%20Affidavit.pdf[*quote*]
AFFIDAVIT
OF GENERAL RELEASE OF LIABILITY AND CLAIMS
PLEASE BE CERTAIN TO READ THIS DOCUMENT IN ITS ENTIRETY. IT CONTAINS
IMPORTANT INFORMATION CONCERNING THE NECESSARY LEGAL RESTRICTIONS AND
INTENDED USE GUIDELINES REGARDING MODALITIES EMPLOYED THROUGH
DELTA
MEMBER SERVICE,
INC
.
Name: _____________
_________________
___________
I,
_______________________________
, swear or affirm:
1.
That Delta Member Services, Inc.
(DMSI)
,
and its authorized representatives,
through phone, internet,
and document relat
ed disclosures have duly informed me that
the modalities and services offered
through
DMSI
have not been evaluated by the Food and Drug Administration.
2.
That
DMSI
and its authorized representatives, through
phone, internet, and document related disclosure
s
have duly informed me that
the modalities and services offered through
DMSI
are NOT considered
scientific by the FDA, nor are they recognized.
3.
That the modalities and services offered through
DMSI
and its authorized representatives,
are for
private memb
ers only and should not in any way be used as a substitute for approved medical treatments
recognized by the FDA, or other applicable agencies of government.
4.
That the modalities and services offered through
DMSI
and its authorized
representatives
are not
intended to be interpreted as medical advice.
5.
That
I have been duly instructed through
DMSI
to
consult with a government authorized physician
before deciding to participate in the various programs offered through
DMSI
.
6.
That
DMSI
, and its authorized repre
sentatives, through phone, internet, and document related
disclosures have duly informed me that
Education and general information offered through DMSI is
never intended to diagnose, treat, cure, or prevent any disease.
7.
That
DMSI
, and its authorized rep
resentatives, through phone, internet, and document related
disclosures have duly informed me that
any and all of the activities and services performed at
DMSI
, are
not to be used to replace the services or instructions of a physician or qualified health c
are practitioner.
8.
That
I have been duly instructed by
DMSI
and it’s authorized representatives
to consult a health care
provider before beginning any cleanse, diet, detoxification program, bio
-
electric modalities,
homeopathic energy catalysts, or any sup
plement regimen.
AFFIDAVIT
Page
1
of 4
9.
That
DMSI
and its authorized representatives have duly informed me that
any use or education
regarding the use of complementary medicine, foods, diet, treatments, nutritional supplements,
homeopathy, colon cleansing, water, energy, bio
-
ele
ctric depletion, general toxicity, and others topics
are for general health related issues and/or educational purposes and are not intended as medicinal,
diagnostic, or for any prescriptive use.
10.
That
I hereby swear that
DMSI
and its authorized representat
ives have never made any medical claims
regarding the use of any and all modalities offered through
DMSI.
11.
That
DMSI
and its authorized representatives have duly informed me t
hat the use of any electrical or
energy based Instrument, apparatus, implement, m
achine, contrivance, reagent, supplement, dietary
item, homeopathic substance, nutritional or oxidative based IV’, oxidative therapy, sauna therapy,
exercise equipment and protocol, or other similar or related article used by
DMSI
on behalf of its
members,
including a component part, or accessory is not recognized in the official National
Formulary, or the United States Pharmacopoeia, or any supplement to them.
12.
That
DMSI
and its authorized representatives have duly informed me t
hat the use of any electri
cal or
energy based Instrument, apparatus, implement, machine, contrivance, reagent, supplement, dietary
item, homeopathic substance, nutritional or oxidative based IV’, oxidative therapy, sauna therapy,
exercise equipment and protocol, or other similar or
related article used by
DMSI
on behalf of its
members, including a component part, or accessory is not intended for use in the diagnosis of disease or
other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other anim
als.
13.
That
DMSI
and its authorized representatives have duly informed me t
hat the use of any electrical or
energy based Instrument, apparatus, implement, machine, contrivance, reagent, supplement, dietary
item, homeopathic substance, nutritional or oxidat
ive based IV’, oxidative therapy, sauna therapy,
exercise equipment and protocol, or other similar or related article used by Delta member Services on
behalf of its members, including a component part, or accessory is not intended to affect the structure
or
any function of the body of man or other animals, and achieves
its primary intended purposes through
non chemical action upon an underlying Sub
-
Quantum Esoteric Field, (SQEF), residing within the
energy fields of man or other animals.
14.
That
DMSI
and it
s authorized representatives have duly informed me t
hat the use of any electrical or
energy based Instrument, apparatus, implement, machine, contrivance, reagent, supplement, dietary
item, homeopathic substance, nutritional or oxidative based IV’, oxidativ
e therapy, sauna therapy,
exercise equipment and protocol, or other similar or related article used by
DMSI
on behalf of its
members, including a component part, or accessory is not dependent upon being metabolized for the
achievement of any of its primar
y intended purposes, though increased efficiency in metabolism or
cellular function may present as an unintended collateral effect.
15.
That
DMSI
and its authorized representatives have duly informed me through repetitive disclosures,
both oral and written, t
hat
every aspect of DMSI’s services are intended to effect nothing beyond the
Sub
-
Quantum Esoteric Field, (SQEF).
16.
That
DMSI
and its authorized representatives have duly informed me through repetitive disclosures,
both oral and written, that
this field (SQ
EF) is represented as a quasi
-
quantum entanglement of energy
AFFIDAVIT
Page
2
of 4
and should not be interpreted as having any relationship to particles, atoms, molecules, matter, motion,
time, energy, or force, including but not limited to the composition, structure, or proper
ties of any such
measurable scientific construct.
17.
That
DMSI
and its authorized representatives have duly informed me through repetitive disclosures,
both oral and written, that
the SQEF can only be understood as a non
-
corporeal, immaterial
metaphysical su
bstance. It could be further defined as a ubiquitous, non
-
quantifiable substance or
energy.
Further affiant saith not.
I SWEAR OR AFFIRM THAT THE ABOVE AND FOREGOING REPRESENTATIONS ARE TRUE AND
CORRECT TO THE BEST OF KNOWLEDGE, AND BELIEF.
___________________________________________
AFFIANT
Date
__/___/_________
STATE OF
___________________________
COUNTY OF
________________________________
I, the undersigned Notary Public, do hereby affirm that
________________________________
personally
appeared before me on the ___ day of
____________
20
_____
, and signed the above Affidavit as his free and
voluntary act and deed.
_____________________________________
AFFIDAVIT
Page
3
of 4
[*/quote*]