Hold Harmless Agreement

Micro-Pulse Indemnification 

This Hold Harmless Agreement is made on this date_________by and between Dr. Stacey Ravid & ___________________. 

Whereas _________________ desires to hold harmless Dr. Stacey Ravid from all liabilities, losses, claims, judgements, suits, fines, or penalties that may result from the participation and consultation with Dr. Stacey Ravid. 

Therefore, in consideration of the premises and the mutual agreements set forth herein, the receipt and sufficiency of which are hereby understood & acknowledged, the Parties hereby agree as follows: 

1. The Micro-Pulse is Not FDA approved. It has not been the intention, nor will it be in the future, to have FDA approval. 
2. Dr. Stacey Ravid is Not a medical doctor and is unable to prescribe medications.  Dr. Ravid is a PhD prepared nurse with over 25 years of nursing experience. 
3. This consultation with Dr. Stacey Ravid is focused on the use of the Micro-Pulse for personal use. 
4. Any advice or suggestions offered by Dr. Stacey Ravid could be shared with your primary care provider for approval. 

I hereby Indemnify Dr. Stacey Ravid to the fullest extent permitted by applicable law, harmless from all claims arising out of this consultation & any future consultation. 

Participant’s Signature  

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