SHE Reset Program

Informed Consent and Release of Liability 

I understand as well that rapid weight loss of over 1-2 lbs. per week is considered by most in the weight loss medical community to be excessive and may lead to ailments similar and in addition to those mentioned above.

Therefore, I understand that my failure to follow the weight loss program exactly as described to me by my health care practitioner can result in severe temporary and/or permanent medical conditions in addition to those mentioned above.

I understand that I am not to follow the program if I am pregnant or think I might be pregnant. 

I additionally understand that the SHE Reset Program is not meant to diagnose, treat or cure any disease or medical condition and that I am to undergo participation in the SHE Reset Program only with the consent and under supervision from my doctor.

I also understand that I should consult with my doctor prior to starting ANY exercise, weight loss or nutritional supplement program. It is mine and my doctor’s responsibility to assure that there are no underlying conditions that would impair the success of the program such as hypothyroidism or any that could endanger my health.

I understand that some underlying medical conditions may be temporarily aggravated such as:

Uncontrolled Diabetes

Blood sugar may drop from day to day, and if diabetes is brittle and poorly controlled, this diet is not appropriate.  The diabetes can go from stable to brittle and this must be managed carefully by primary care physician or whoever is administering ant diabetic medications. This is more likely if managed with insulin. The need for medication may decrease or be unnecessary as weight loss ensues. Blood sugar must be checked regularly.


Total cholesterol levels may soar higher as cholesterol is mobilized from non-calcified plaque. This is expected to remit several months after treatment. In many cases, the cholesterol levels will improve from pretreatment levels after several months.


It is possible to get a severe and acute attack of gout with a marked elevation in uric acid during the initial stages of treatment. The level of uric acid may remain elevated for months after treatment. In many cases, gout attacks cease and do not recur regardless of what is eaten unless another course of treatment is begun. Taking Allopurinol may prevent an attack.

Blood Pressure

Low blood pressure may rise to normal and may drop, whereas high blood pressure generally gets lower. The drop-in blood pressure may be sudden

Hair loss

If hair loss has been an issue, the diet may temporarily arrest this condition followed by a recurrence once the diet is stopped. In rare cases, an increased loss of hair is reported.


Complete absence of fat from the diet may not allow the gallbladder to empty. If you have a history of gallbladder pain, symptoms may become more frequent and severe and may necessitate surgery.

History of Coronary Occlusion

Electrocardiographic changes must not be present for 3 months before embarking on this restrictive diet.

Contraindications to Diet

I attest that I do not have any of the following health conditions.  I understand that if any of these conditions are present, the diet is not appropriate.

  • Cancer
  • Diabetes (brittle or uncontrolled)
  • Heart Attack
  • Insulin Dependent Diabetes
  • Transient Ischemic Attack (TIA or mini stroke)
  • Stroke
  • Unstable Angina
  • Tumors (benign or malignant)
  • Pregnant or nursing
  • Eating Disorders like Anorexia Nervosa

I hereby consent to, the SHE reset program and agree to follow the recommendations and instructions of my physician and health care practitioner. I further agree not to use or consume any nutraceutical product without the advice, counsel, and recommendations of my physician. I understand that this is a wellness program performed by certified health coaches and licensed practitioners and does not establish a doctor patient relationship.

I hereby release, discharge and agree to indemnify my health care practitioner(s), their agents, servants, employees and affiliates from any and all liability, claims, causes of action and demands for personal or bodily injury or death that I or my personal representatives might have or might hereafter acquire through my participation in the SHE Reset Program 

I acknowledge that this program does not constitute a doctor patient relationship with Dr. Rajka and while physician approved is health coach and nutrition led.