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What are the most important concerns I can help you with today, and how severe are they?

Please list your concerns and then rate their intensity, using a scale of

0 to 10 0 = barely noticeable and 10 = very severe

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Rate from 0 to 10

Prior to obtaining any of the services: Ranie Kitingan, I certify that I clearly understand the following:    


I choose to consult with Ranie Kitingan as a natural health counselor who conveys self-help information that people can use to enhance wellbeing. I affirm my right to self-health, and I take full responsibility for my healing process with her guidance and support. I state that I come to Ranie Kitingan with the purest of heart and purpose of seeking information. I state that I do not come with any forethought or will have any afterthought to entrap Ranie Kitingan into an illegal statement or action. I understand that Ranie Kitingan's sole intention is to offer information that will help to bring homeostasis into my body/condition. If I choose to use this information for myself or loved ones, then I affirm that the responsibility is mine. I understand that Ranie Kitingan does not provide legal medical services, but instead suggestions that I can choose to use for healing. I will not consider her advice or anything that she says to replace the treatment of a licensed primary healthcare provider or medical doctor. Ranie Kitingan is not a licensed health care provider or a medical doctor. She does not diagnose, prescribes, or treat defects, injuries, or diseases. 

By submitting this form, I acknowledge, understand and agree to the above statements.

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