Health Check Form – Step 4

Almost done ,

Please read the sections below very carefully and acknowledge your understanding and acceptance by ticking the checkbox below each section.

STEP 4:

Section 1 – Understanding the Program

I have received and understood the information about the program led by Coach Dieter Buchner, including the Buchinger fasting method (with organic juices, vegetable broth, herbal tea, mineral water), and activities such as walking, cycling, yoga, meditation, hydrotherapy & massage, salt drinking, coffee enema, optional swimming in the pool, and pre-program instructions (hereinafter referred to as the “Program”).

I understand that the Program helps improve health, support weight loss, and enhance quality of life, but it is not a form of medical treatment.

Fasting may alter the way certain medications act in your body, including those listed below. Changes in absorption, potency, or side effects may occur, which can affect your health and safety during the Program. It is therefore very important that you inform us if you are taking any of these medications during our retreat preparation call, so that appropriate precautions and recommendations can be discussed.

• Strong anti-blood clotting or blood thinning drugs (Anticoagulants, i.e. Simvastatin) • Anti water retention drugs (Diuretics) • Anti-Hypertension drugs (i.e. Beta blockers, ACE inhibitors) • Appetite reducers • Laxatives • Hyperthyroidism medication • Blood sugar regulating drugs • Hormone regulating drugs (incl. insulin, cortisone, etc.) • Psychotropics (incl. antiepileptics, neuroleptics and lithium)

Expecting and breastfeeding mothers, people with depressive moods or mental disorders as well as people who had recent surgery cannot fast. Please take note that oral contraceptives (the pill) may not provide safe protection from pregnancy during fasting. Please speak with your medical consultant, MD or physician and as a pre-caution get yourself a medical clearance from your doctor.

I HAVE READ AND UNDERSTOOD SECTION 1

Section 2 – Personal Health Responsibility

I voluntarily participate and take full responsibility for my health during and after the Program, including while practicing the Buchinger fasting method and engaging in cycling, walking, yoga, meditation, hydrotherapy & massage, and swimming.

I commit to providing accurate information regarding my health condition, medical history, food allergies, or any medical issues that may affect my participation.

I understand that the Buchinger fasting method and physical activities may not be suitable for certain health conditions (such as pregnancy, type 1 diabetes, heart disease, or eating disorders).

I have evaluated or consulted my doctor’s opinion to ensure my health condition is safe for participation. If there are any health concerns, I agree to consult my doctor before joining. Vietnam Detox reserves the right to refuse participants if they do not present a medical certificate and have health concerns.

I HAVE READ AND UNDERSTOOD SECTION 2

Section 3 – Disclaimer, Compliance, and Conduct

I agree that Urban Healing Co., Ltd. (“Vietnam Detox”) and its staff shall not be held responsible for any health, financial, or mental issues arising from my participation in the Program, except in cases where it is proven that such consequences are the direct result of gross negligence or willful misconduct by the Company or its staff.

I understand that risks from the Buchinger fasting method or physical activities (such as accidents while walking or cycling, muscle strain during yoga, or incidents while swimming) may occur, and I take full responsibility for these risks.

Swimming in the pool is optional, and I am responsible for assessing my own swimming ability as well as complying with the safety guidelines of the venue.

I commit to following all instructions, regulations, and schedules of the Program, including safety rules, fasting practices, and guidelines for cycling, yoga, meditation, massage, and swimming.

I confirm that I have read, understood, and agreed to all the terms of this commitment. All information I have provided is accurate, and I am voluntarily participating in the Program with full awareness of my own responsibility.

I HAVE READ AND UNDERSTOOD SECTION 3 AND ACCEPT THE TERMS AND CONDITIONS AS OUTLINED IN SECTIONS 1-3.