1. I am an existing client and have completed the mandatory 1-month coaching programme.

2. I have not provided my patient number to any other parties.

3. My health problems, past medical history and medications have not changed since my initial consultation if they have I agree to complete the online health assessment.

4. The undersigned, hereby unconditionally accepts the treatments of Abilities Behavioural Weight Management (“the practitioner”) for the Reshape Weight Loss Program.

5. Confirm that I am fully aware of the practitioner’s tariffs and accept them unconditionally.

6. The Reshape programme may be repeated with my express written consent.

7. I am aware that my medical scheme does NOT pay for the Reshape Programme because they deem it to be cosmetic treatment, and I accept responsibility for payment of the amount due for professional services rendered and medicine dispensed and supplied, and products purchased, and supplied.

8. No action will be taken against the practitioner on the grounds of misrepresentation, or the absence of informed consent by me, during the Reshape Programme.

9. Confirm that this contract, read with my patient details, and documentation the medicines prescribed, admixed, compounded and supplied, and the products ordered by me from time to time, contains all the agreed terms between the practitioner and me as client, and no other agreement or promise, oral or written, will be valid, unless reduced to writing and signed by both the practitioner and me.