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Consent* By completing this registration form you give consent to Rhythm Health Ltd to utilise your data for marketing purposes on their website in exchange for two months’s worth of complimentary Life Shot 200's. Data may include first and second name, age, test results and any feedback you may provide, not your location. You agree to provide a recent (within 3 months) positive SIBO breath test result before beginning the trial in order to validate this agreement. You agree to purchase a final non refundable breath test before commencing the trial at our website or from your healthcare practitioner, by consenting here, you are also agreeing for them to share the breath test results with Rhythm Health Ltd, once we have contacted them. The final breath test you will then receive at the end of the trial. YesNo
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Your Year of Birth [/vc_column_text][vc_column_text]
Your Address will be used to ship your complimentary Life Shot 200s [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
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[/vc_column_text][vc_empty_space height="16px"][vc_column_text] You agree to follow the protocol dietary advice section on the website during the trial? YesNo [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
Have you been treated with antibiotics for SIBO? YesNo [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
Within the last four weeks? YesNo [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
Full details of your healthcare practitioner whom you had there breath test through: [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
You consent to purchasing final breath test before commencing on the course through the Rhythm Health web store. YesNo
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Disclaimer* The Rhythm Health Life Shot range is not a medical product and it is not intended to treat medical conditions. Rhythm Health doesn't accept any liability for adverse reactions experienced during the trial, you are enrolling in this trial at your own risk. You should follow the guidance of a qualified professional whilst consuming the Life Shot 200 product. You are required to provide feedback to Rhythm Health Ltd on any reactions experienced (if applicable). You are required to notify Rhythm Health Ltd if you wish to withdraw from the trial. YesNo [/vc_column_text][vc_empty_space height="16px"][vc_column_text]
I consent to the Privacy Policy* [/vc_column_text][/vc_column][/vc_row]