By purchasing your Custom Supplement Product you are acknowledging that you have read and agree to all of information, statement and guidelines found on this website under the section of this website entitled: Custom Supplement Acknowledgment Form and Agreement/Permission Slip
Custom Supplement Acknowledgment Form and Agreement/Permission Slip

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Thank you for making the decision to purchase a custom nutritional supplement. Dr. Michael Wald has recommended this supplement to you for one or more of the reasons below.

You are acknowledging and agreeing to the following:

  •  Your custom product is meant to enhance your overall nutritional efforts. 
  • You have chosen either a custom powdered product or capsules for one full year or thereabouts; due to manufacturing techniques your custom product may contain 2-3 weeks less or more product than the full year’s supply that you ordered.
  • Your custom product contains a variety of nutritional compounds chosen by Dr. Michael Wald based upon his training and experience in the field of nutrition.
  • The dosages/levels/amounts of nutritional supplements in terms of units (for example - milligrams(mg), grams (g), IU (international Units), but not limited to these units, may be higher or lower than those of the Recommended Daily Allowances (RDA), Recommended Daily Intakes (RDI), Recommended Daily Values (RDV) and/or other dosages/levels/amounts or other units that may be considered as guides and/or recommendations or otherwise suggest guidelines for individuals.
  • Dr. Wald may recommend certain nutritional supplements to you even though laboratory testing does not demonstrate an outright deficiency based on laboratory normal or clinical ranges.
  • Your compounded supplement is not a substitute for a balanced diet or for medications.
  • Your compounded supplement is not a substitute for sound medical or health advice. You are free to discuss Dr. Wald’s recommendation for a custom product with your medical doctor before signing this agreement.
  • No claims whatsoever are implied or promised regarding your health condition(s) and use of your custom product.
  • Your custom product is not a treatment for any medical or health condition.
  • Your compounded product is non-refundable, in part or full, for any reason whatsoever including, but not limited to, adverse reaction and intolerance.
  • Once you or Dr. Wald has placed your custom product order, either in the form of cash, credit card, money order, online or any other form of payment, you are agreeing and acknowledging this no refund policy for any reason whatsoever.
  • If any portion of this agreement is deemed unenforceable the remainder of this agreement shall remain intact. There are no exceptions to this no-refund policy. 
  • Your compounded supplement is considered experimental:

 

Investigational" or "Experimental

"Investigational" or "experimental" refers to the use of a service, procedure or supply that is not recognized by your insurance company and/or the FDA (Food and Drug Administration) and/or the AMA (American Medical Association) or other appropriate boards and/or governing bodies or organizations (all of the aforementioned considered as “PLAN”), as standard medical care for the condition, disease, illness or injury being treated. A service, procedure or supply includes, but is not limited to the diagnostic service, treatment, facility, equipment, drug or device. A service is considered investigational (experimental) if any of the following criteria are met:

 

  1. The services, procedures or supplies requiring Federal or other Governmental body approval, such as drugs and devices, do not have unrestricted market approval from the Food and Drug Administration (FDA) or final approval from any other governmental regulatory body for use in treatment of a specified condition. Any approval that is granted as an interim step in the regulatory process is not a substitute for final or unrestricted market approval.

 

  1. There is insufficient or inconclusive medical and scientific evidence to permit the Plan to evaluate the therapeutic value of the service, procedure or supply. (Adequate evidence is defined as at least two documents of medical and scientific evidence that indicate that the proposed treatment is likely to be beneficial to the member.)

 

  1. There is inconclusive medical and scientific evidence in peer-reviewed medical literature that the service, procedure or supply has a beneficial effect on health outcomes.

 

  1. The service, procedure or supply under consideration is not as beneficial as any established alternatives.

 

  1. There is insufficient information or inconclusive scientific evidence that, when used in a non-investigational setting, the service, procedure or supply has a beneficial effect on health outcomes or is as beneficial as any established alternatives. 

 

If any portion of this notice is deemed unenforceable the remainder will remain potentially enforceable and in effect.