supplement voluntary consent form

 I was not given any guarantees of cure for any ailment. I was advised on proper administration, which is to take one dropperful, intranasally, preferably at bedtime or morning. I am to take the supplement for a minimum of one month to allow for proper assessment of effectiveness.  

However, I may stop use of the supplement at any time.  I have been made aware of the potential side effects of increased libido and increased appetite. Store the supplement in a cool, dry place, not in the sunlight!