Agreement for Remote Clients

Once you have completed and submitted this form, you will be directed to the payment page.


Bio-energetic testing is a completely noninvasive method of gaining valuable information about your body’s vital functions. The primary objective is to disclose patterns of stress and provide balancing via imprinted frequencies. The imprint drops we custom formulate for you will give you the exact dosages that you need to balance each of your most causal energetic imbalances. We do not “diagnose” or “treat” clients but instead assist you with “self-healing.” We maintain that the body was designed by God to be healthy but sometimes it just needs re-directing so that it can overcome toxicity and other imbalances. We have a comprehensive website that explains how we do what we do and how we work ( We encourage you to take a look at it.


I understand that Organic Health Systems does not provide medical diagnosis, diagnose, cure, prevent or treat disease and is not a medical office. I understand that OHS energetic balancing is not a substitute for medical treatment and that I am actually responsible for the removal of my own imbalances. If I suspect that I need medical intervention, I understand that I should consult my physician. I understand that OHS staff are not physicians and in doing my testing, my energy practitioner is not becoming my primary care physician. Any decision to follow through with the recommended program is my own decision and I hold the OHS and office staff blameless. I understand that I should continue to see any medical doctors I am currently under the care of, and any prescribed medication should not be altered without first consulting the physician who recommended it. I fully understand that those who counsel me are not medical doctors, medical practitioners, licensed nutritionists or naturopaths. I am not here for medical diagnostic purposes or treatment procedures. I agree that OHS may at any time discontinue evaluations of any kind at its sole discretion. I understand that remote purchases are not interchangeable between family member and friends.




I understand that subscription rates are discounted and subscription clients are reserved space in the testing schedule. I understand that subscriptions are designed for clients who are committed to their health and the imprinting process, and that otherwise they should opt for single remote testing. I understand that subscriptions require a commitment of at least 12 remote tests before discontinuing and that subscriptions cancelled prior to that time will be charged a $350.00 cancellation fee. I understand that subscriptions include receiving new imprint bottles every 6-7 weeks and that I will discard the old bottles and start the new ones when I receive them. I also understand that in the event of an emergency, subscriptions can be paused once a year for 6 weeks but must be resumed at that point.


Supplement and Imprint Orders


I understand that to receive imprints and certain supplements I must be a current, active client, meaning I must have had remote testing done within the last 6 months.

OHS uses a photograph for remote energetic balancing. Photographs need not be recent but should be of the applicant only and not include other people, pets etc.
Click or drag a file to this area to upload.


(OHS respects your privacy and does not share client information)

OHS must have a separate, completed application for each individual.

CLIENT APPLICATION (this is the person who is receiving the remote)


(Person responsible for payment, if other than applicant)


I agree that all purchases of Energetic Balancing are final and that there are no refunds. I agree that an executed photocopy or digitally or photographically archived copy of this document shall have the same force and effect as an executed original document.

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