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.



Section 1 – Fasting and medication

During fasting, the effects of medication can alter. If you are taking one or more of the medication listed below, therapeutic fasting under medical supervision can be more sensible or even directly indicated.

• 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.

Section 2 – Preventative Fasting and your responsibilities

I am aware that the above detox programme is positioned as “Fasting and hiking for healthy people”, meaning it is preventative fasting and not therapeutic fasting under medical supervision.

By signing this questionnaire, I confirm I am healthy and agree it is my responsibility to get a medical diagnosis or treatment from a medical doctor. I accept full responsibility for my actions during the detox retreat. I will not claim liability against the retreat leader, retreat organizers or others supporting the event.

Section 3 – Liability and acceptance

I will not claim liability against the retreat leader, retreat organizers or others supporting the event.

I have read and understood these conditions of participation in the above detox retreat and agree to these conditions.

The organizers or the retreat leader accept no responsibility for any items brought to the retreat by the participants.

Your Signature


Health Check Form – Step 4

Xin Chào, tôi là Dieter Buchner, Huấn luyện viên tiết thực phương pháp Buchinger và Người lãnh đạo khóa tiết thực đã được chứng nhận của bạn.

Tại đây, bạn có thể tùy chọn số lượng người tham gia, gói dịch vụ, xe đưa đón v.v… Và hoàn thành đăng ký tham gia.


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