» I understand that all information on the
form will be kept in strict confidence between David Johnson
and Dr. Leela.
The information on the form is accurate and
provided to the best of my knowledge.
» I will contact my local
health care professional for any and all
» I understand that homeopathic remedies are
extremely safe, but during the process of healing I may
experience temporary nuisance symptoms (eg., muscle soreness,
etc.), which are beyond the control of the
» I agree to pay at three-month intervals
for as long as I choose to continue and the doctors and I
jointly conclude I am experiencing benefit from