First Time Remote Consultation Information
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1 Original Design Wellness Center A Private Healthcare Membership Association 9227 Township Road 82 Millersburg, Ohio Phone: (330) Fax: (330) ODWC@PrecisionHerbs.com First Time Remote Consultation Information If you are interested in having a Remote Consultation, YOU (the person wanting the consultation) will need to fill out the Client Information & Statement and Symptoms & Questions forms. Please use blue or black ink pens only, as felt tip or gel pens will not work. Your signature is required before we will submit your request to the health consultants. Please read the client statement at the bottom of the form before signing. If you are requesting to have a consultation for a small child or for someone that cannot fill out the form, indicate that the form was filled out by someone else and that the drawing, markings, (face) photo or signature is from the person wanting the consultation. Attach a hand written or typed letter describing your health concerns and issues that you would like the health consultant to test. Please be specific. Also attach a glossy photo of the person wanting to be tested. Please read and complete the Private Healthcare Membership Association form. (You do not need to send the $10.00 membership fee, it will be applied to your account, then credited back to you.) Please enclose a credit card number or check/money order for $85.00 made payable to Original Design Wellness Center for the consultation fee. Please mail these forms the first time because a fax copy or will not work. Once received, one of our health consultants will test you using your handwriting sample and (face) photo. Consultations are done in the order that they are received. When your consultation has been completed, one of our friendly receptionists will notify you of the results and recommendations. If you prefer being notified of your results in a particular way (phone, fax or ) please indicate this on your form. Follow-up consultations (also known as Rechecks) can be done by phoning, faxing or ing us your issues and/or health concerns. If you have any questions, please call (330) Mon.-Fri. 8am-5pm. Thank you, Original Design Wellness Center, PHMA
2 Original Design Wellness Center A Private Healthcare Membership Association 9227 Township Road 82 Millersburg, Ohio Phone: (330) Fax: (330) ODWC@PrecisionHerbs.com Questions & Answers about Herbs What are Herbs? Herbs are the highest quality food known to man containing vitamins, minerals and trace elements in natural balance and harmony. Why use Herbs? It is our sincere belief that our Creator put herbs upon the Earth to maintain and restore our health. We believe that herbs can get to the root cause of health problems. Are there side effects? No. However, some people experience a cleansing action by the body when beginning an herbal program. (IE: nausea, diarrhea, skin rash, aches, etc.) It is this detoxifying process that helps bring the body back into a healthy state. Are Herbs treated like Drugs?(IE:small dosages, caution in mixing and possible overdose?) No. Herbs are food, drugs are chemicals. Herbs can be taken in large quantities with no side effects. Mixing herbs has less side effects than eating different foods together, therefore, you can take all the necessary herbs you need for greater health benefits. Most chemical drugs can be taken with herbs, but it is preferable to take them at different times. How many Herbs should I take and for how long? When starting a new nutritional program, begin with the recommended dosage and observe how your body reacts. If you do not achieve the desired result, slightly increase or decrease the dosage accordingly. When herbs are used for restoring health, dosages will be 5 to 7 times that which is required for maintaining health. Getting well and repairing your body will depend on the specific ailment and the severity of it. The science of Homeopathy teaches that it takes one month for every year of illness for a person to rebuild the body. (Dr. Jack Ritchason, The Little Herb Encyclopedia.) How soon should I see results? It s impossible to give a set answer. There are many factors involved; the ailment and the severity of the ailment, the person s assimilation and digestive system, etc. However, some problems (IE: constipation, etc.) can usually get excellent results within a day or two, while someone with more debilitating problems may not feel any difference for weeks or longer. Can I quit taking my chemical drugs? Herbs are a slow, safe cure. Do not quit taking drugs that you re dependent on. Many people have gradually decreased drug dosage and frequency of use with the use of herbs. When is the best time to take Herbs? Since herbs are food, you may take them whenever you want. Most people take them before or with their meals. Others, on a busy schedule, may take them in the morning and again at night. Herbs for insomnia or cleansing are generally taken before bedtime. Herbs for appetite depressants or blood sugar balancers are best taken minutes before meals. Dosages should be taken at least 4-5 hours apart, unless recommended otherwise. Don t forget the importance of a well-balanced diet and drinking plenty of water daily!
3 Explaining Kinesiology (Muscle Testing) Two basic methods are used to find out what is wrong with your health: 1. Asking questions 2. Muscle testing While muscle testing, you ll be asked to hold your arm straight out from your side. You will be able to resist the health consultant pushing your arm down. This test is based on the fact that your brain knows everything about your body even though you may not be consciously aware of it. If attention is called to a weak organ, your brain will temporarily weaken your muscles, including the test muscle holding up your arm. This temporary weakness will also happen if a statement is made about your body that is untrue. You won t be able to resist the health consultant pushing your arm down. The herbal test samples have an electromagnetic field around them. If you are touching them or if the health consultant is touching them and touching you, and if the product will help your weak organ, your brain will sense this and strengthen your muscles. You will be able to resist the health consultant pushing your arm down. The health consultant will be able to recommend which products and dosage will benefit you in a monthly program. Muscle testing is not infallible. There are some things that can interfere, but health consultants are trained and can usually catch the problems. It is the best tool anyone has for assessing your health needs. You may see the health consultant using their fingers to test you instead of your arm. This is to give your arm a rest and is sometimes faster.
4 Information on Remote Consultations Handwriting Test A person s handwriting records the vibrational imprint of the person s organs and physical substances; thus it acts as a suitable medium for muscle testing. The health consultant will touch the writing with one hand, while muscle testing with the other. Handwriting test results are for the time of the test, not the time of the writing. Therefore, it can also be used for follow-up programs or questions in between consultations in the absence of the person. Testing of photo copies or faxes of the handwriting will not work. Dr. Overman believes handwriting samples will work for as long as the person lives. The ability of the sample to be muscle tested ceases instantaneously upon the death of the person. When the person dies his handwriting sample no longer works. This leads Dr. Overman to believe that the handwriting works as a resonator, magnifying waves emanating from the living writer. Muscle testing handwriting samples is not to be confused with handwriting analysis, which is sometimes used as a form of divination. Divination is condemned in the Bible. Glossy Photo Test A color or black and white, glossy photo of the person records a vibrational imprint of the entire person s organs and physical substances, thus it can be used as a medium for muscle testing. At least a small amount of skin must be visible in the photo. The health consultant will touch the exposed skin in the photo with one hand while muscle testing with the other. Please do not send nude photos. It is neither necessary nor appreciated. Touching the picture on a computer or video screen will not work. Testing of photo copies or faxes of photographs will not work. Glossy photo test results are for the time of testing, not the time of picture taking. Therefore, it can be used for follow-up programs or questions in between consultations in the absence of the person. There is little difference between handwriting testing and glossy photo testing. Muscle testing a color or black and white, glossy photo is not to be confused with voodoo spells using a likeness of a victim. Such pagan practices are condemned in the Bible.
5 CLIENT STATEMENT I UNDERSTAND THAT I AM HERE TO LEARN ABOUT NUTRITION AND BETTER HEALTH PRACTICES AND THAT I WILL BE OFFERED INFORMATION ABOUT FOOD SUPPLEMENTS AND HERBS AS A GUIDE TO GENERAL GOOD HEALTH AND THAT THIS IS CONSIDERED A PERSONAL MINISTRY COUNSELING SERVICE. I UNDERSTAND THAT I AM TAKING FULL RESPONSIBILITY FOR ALL DECISIONS CONCERNING MY HEALTH AND HEREBY RELEASE ORIGINAL DESIGN WELLNESS CENTER, A PRIVATE HEALTHCARE MEMBERSHIP ASSOCIATION AND ALL THEIR EMPLOYEES FROM ANY LIABILITY WHATSOEVER. I FULLY UNDERSTAND THAT THOSE WHO COUNSEL ME ARE NOT MEDICAL DOCTORS OR PRACTIONERS AND I AM NOT HERE FOR MEDICAL DIAGNOSTIC PURPOSES OR TREATMENT PROCEDURES. I AM NOT ON THIS VISIT OR ANY SUBSEQUENT VISIT AN AGENT FOR FEDERAL, STATE OR LOCAL AGENCIES OR ON A MISSION OF ENTRAPMENT OR INVESTIGATION. THE SERVICES PERFORMED BY ERIC A PIERCE AND/OR OTHERS AT THIS LOCATION ARE AT ALL TIMES RESTRICTED TO THE SUBJECT OF NUTRITIONAL MATTERS INTENDED FOR THE MAINTENANCE OF THE BEST POSSIBLE STATE OF NUTRITIONAL HEALTH AND DO NOT INVOLVE THE DIAGNOSING, TREATMENT OR PRESCRIBING OF REMEDIES FOR DISEASE. I UNDERSTAND THAT FREQUENCY GENERATORS HAVE BEEN DEMONSTRATED BY RESEARCHERS TO KILL SOME PARASITES; THAT FREQUENCY GENERATORS HAVE NOT BEEN APPROVED BY THE AMA FOR USE ON HUMANS; THAT NO MEDICAL CLAIMS ARE MADE OR IMPLIED BY THE MANUFACTURER OR BY ORIGINAL DESIGN WELLNESS CENTER, A PRIVATE HEALTHCARE MEMBERSHIP ASSOCIATION OR THEIR EMPLOYEES AND PRECISION HERBS, A PRIVATE HEALTHCARE MEMBERSHIP ASSOCIATION ; THAT FREQUENCY GENERATORS SHOULD NOT BE USED BY PREGNANT WOMEN OR PEOPLE WITH PACEMAKERS; THAT THE USE OF FREQUENCY GENERATORS AND OTHER EQUIPMENT ARE LOANED WITHOUT CHARGE FOR RESEARCH ONLY FOR MY VOLUNTARY USE AT MY OWN RISK. I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENT
6 *Complete Name: CLIENT INFORMATION AND STATEMENT * REQUIRED *Spouse: *(For clients under 18 years of age) Father: Mother: *Physical Street Address: *City: *State: *Zip-code: *Contact: Home Work Cell Fax Address: HEALTH INFORMATION 1. HAVE YOU EVER HAD OR BEEN DIAGNOSED AS HAVING PROBLEMS WITH ANY OF THE FOLLOWING? ANEMIA ARTHRITIS DIGESTION CIRCULATION LIVER DIABETES KIDNEYS LUNGS STOMACH CANCER HEART/PACEMAKER? FAINTING BLEEDING HIGH BLOOD PRES. HEARING LOSS PROSTATE HYPOGLYCEMIA PMS ALZHEIMER S SLOW LEARNER NERVES OVARIES ASTHMA HAY FEVER EYE PROBLEMS THYROID THROAT EPILEPSY HEMORRHOIDS SPLEEN SKIN BREAST COLON CONSTIPATION WEIGHT GALL BLADDER BLADDER SPINE/BACK PARASITES EDEMA TUMORS PANCREAS STRESS OTHER PROBLEMS 2. BLOOD TYPE 3. WERE YOU BREASTFED? 4. OCCUPATION: *DATE OF BIRTH: 5. ARE YOU ALLERGIC TO ANY FOOD OR MEDICATION? 6. WHAT CONDITIONS ARE YOU CURRENTLY UNDER A PHYSICIANS CARE FOR? 7. PLEASE LIST ANY MEDICATION(S) YOU ARE TAKING: 8. ARE YOU PREGNANT? IF SO, NUMBER OF MONTHS: 9. WERE YOU REFERRED BY A NATURAL HEALTHCARE PROVIDER? NAME: 10. WHO REFERRED YOU TO US? NAME: CLIENT STATEMENT I UNDERSTAND THAT I AM HERE TO LEARN ABOUT NUTRITION AND BETTER HEALTH PRACTICES AND THAT I WILL BE OFFERED INFORMATION ABOUT FOOD SUPPLEMENTS AND HERBS AS A GUIDE TO GENERAL GOOD HEALTH AND THIS IS CONSIDERED A PERSONAL MINISTRY AND COUNSELING SERVICE. I UNDERSTAND THAT I AM TAKING FULL RESPONSIBILITY FOR ALL DECISIONS CONCERNING MY HEALTH AND HEREBY RELEASE ORIGINAL DESIGN WELLNESS CENTER, A PRIVATE HEALTHCARE MEMBERSHIP ASSOCIATION AND ALL THEIR EMPLOYEES FROM ANY LIABILITY WHATSOEVER. I FULLY UNDERSTAND THAT THOSE WHO COUNSEL ME ARE NOT MEDICAL DOCTORS OR PRACTITIONERS AND I AM NOT HERE FOR MEDICAL DIAGNOSTIC PURPOSES OR TREATMENT PROCEDURES. I AM NOT ON THIS VISIT OR ANY SUBSEQUENT VISIT AN AGENT FOR FEDERAL, STATE OR LOCAL AGENCIES OR ON A MISSION OF ENTRAPMENT OR INVESTIGATION. THE SERVICES PERFORMED BY ERIC A PIERCE AND/OR OTHERS AT THIS LOCATION ARE AT ALL TIMES RESTRICTED TO THE SUBJECT OF NUTRITIONAL MATTERS INTENDED FOR THE MAINTENANCE OF THE BEST POSSIBLE STATE OF NUTRITIONAL HEALTH AND DO NOT INVOLVE THE DIAGNOSING, TREATMENT OR PRESCRIBING OF REMEDIES FOR DISEASE. I UNDERSTAND THAT FREQUENCY GENERATORS HAVE BEEN DEMONSTRATED BY RESEARCHERS TO KILL SOME PARASITES; THAT FREQUENCY GENERATORS HAVE NOT BEEN APPROVED BY THE AMA FOR USE ON HUMANS: THAT NO MEDICAL CLAIMS ARE MADE OR IMPLIED BY THE MANUFACTURER OR BY ORIGINAL DESIGN WELLNESS CENTER, A PRIVATE HEALTHCARE MEMBERSHIP AND PRECISON HERBS, A PRIVATE HEALTHCARE MEMBERSHIP ASSOCIATION; THAT FREQUENCY GENERATORS SHOULD NOT BE USED BY PREGNANT WOMEN OR PEOPLE WITH PACEMAKERS; THAT THE USE OF FREQUENCY GENERATORS AND OTHER EQUIPMENT ARE LOANED WITHOUT CHARGE FOR RESEARCH ONLY FOR MY VOLUNTARY USE AT MY OWN RISK. I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENT *SIGNATURE OF CLIENT DATE: **SIGNATURE OF PARENT OR GUARDIAN IF CLIENT IS UNDER 18
7 Symptoms and Questions List your present health problems in order of importance to you Additional Information:
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