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I, the undersigned (“Client”) accept the terms and agreement under the administration of by Ms. Divine G. Tria, RND. I fully acknowledge, read and understand the content of this matter as enumerated below.

1. Acceptance of the counselling service offered by Divine Tria, RND of DIET RX PH as a form of guidance in dietary management and other things related to this matter to obtain optimal health and nutrition condition within the clients’ control and was not being forced to accept the service or in giving personal information.

2. Acknowledge that this Nutrition Counseling does not function as a replacement of physicians order nor dispense medical advice, prescription and diagnosis. Rather it is a form of education that helps the client to have better understanding about nutrition, food and balance diet and will benefits greatly as a way of improving health and nutritional status of the client.

3. Understand thoroughly the nature of individualized recommendation which implies that all information is personally computed and assessed within the client’s profile and will not be suitable for any other individuals to be transferred, copied, or sold.

4. Aware about the therapy notes to record all the discussion and nutritional intervention and therapy plan of the Client. Records will be disclosed and will be securely keep between the two parties specifically the undersigned of this agreement. Please note for any changes or side effects during the changes should be consulted immediate to the physician as well as to the dietitian for us to do necessary adjustment needed.

Agree to hold Divine Tria harmless for claims and damages during the whole consultation between the two parties involved. Not unless during the act of willful misconduct or gross negligence. Professional fees or any other service charges should be shouldered fully by the Client.


In compliance with RA_10173 also known as the Philippine Data Privacy Act of 2012, whose implementing Rules and Regulations took effect on September 9, 2016, you hereby agree and consent managed by Divine Tria, RND, may collect, use, disclose and process your personal information that will be provided by this form.
By checking the box, you agree to the above mention terms, condition, liability agreement and Personal Data Consent stated. A Full Copy of it can be viewed at
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