BILL OF RIGHTS

Practitioner’s Name and Contact Information:

1) Glenn Forman, Medical Intuitive | Energy Balancing| DNA | Matrix | UpLevel | Body Code (CBCP)| Emotion Code (CECP)| and More!!


Business Name and Address:

Activate Wellness – The DNA Guy
P O Box 701
Kilauea, HI 96754

The State of Hawai’i has not adopted any educational and training standards for unlicensed health care practitioners. This statement of credentials is for information purposes only.

The treatment(s) is an alternative or complementary health care service.

Under Hawai’i law, an unlicensed health care practitioner may not provide a medical diagnosis. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a licensed physician, chiropractor, nurse, osteopath, physical therapist, dietician, nutritionist, acupuncture provider, athletic trainer, or any other type of health care provider, the client may seek such services at any time.

Pay methods accepted:

Visa, American Express, Mastercard, Discover, PayPal. We do not accept any insurance, including Medicaid. If special circumstances prevent full payment, please notify us before sessions to begin to arrange a mutually acceptable payment option.

Description of methods:

The services provided, including The Body Code and The Emotion Code (as taught by Dr. Bradley Nelson), DNA, Matrix, UpLevel, and other energy healing modalities that may be used by Activate Wellness – The DNA Guy practitioner(s), as part of this healing work, and as practiced by the practitioner(s) listed above, seek to identify and eliminate underlying imbalances by releasing energetic imbalances in the body and energy field. These methods of energy healing promote harmony and balance within, relieving stress and supporting the body’s natural ability to heal. Energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.

Your rights:

You have a right to expect reasonable notice of any changes in services or charges. Such notice will be provided before an appointment is scheduled, and otherwise, typically sent within no less than one month of the effective change via email to the email address you have provided to us.

You have the right to complete and current information concerning the practitioner's assessment and recommended service that is to be provided, including the expected duration of the service to be provided.

You have the right to simple information and explanations to help you understand, including an explanation of energetic imbalances and the choice of releasing and creating balance, including not releasing, thereby not creating balance.

You have the right to expect to be free from verbal, physical, or sexual abuse by the practitioner.

As a client of this business, you have the right to file a complaint with the Hawai’i Department of Health.

Your client records and transactions with your practitioner(s) are confidential, unless release of these records is authorized in writing by the client, or otherwise provided by law.

You have the right to be allowed access to records and written information from records, provided to you through a secure online portal.

You have the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs.

You have right to be referred to someone else.

You have the right to a coordinated transfer when there will be a change in the provider of services.

You have the right to refuse services or treatment, unless otherwise provided by law.

You may assert these client’s rights without retaliation.

You are responsible to:

Be Informed.

Understand the explanation of any energetic imbalance found.

Ask if you have questions. You have the choice to accept or refuse treatment.

Be in charge of your health, emotional, physical, spiritual care.



Prior to the provision of any service, you as the unlicensed health care client must sign and date this written statement attesting that you have received the unlicensed health care client bill of rights.

I have received and read the Client's Bill of Rights: