We highly recommend coming to the Gerson Clinic in Mexico to get ... following: 3
books: Healing the Gerson Way, A Cancer Therapy and the Gerson Therapy ...
Coaching Service Program
Dear Sir/Madam, Thank you for your interest in the Gerson Therapy. We highly recommend coming to the Gerson Clinic in Mexico to get started on the therapy. If this is not possible, then you may choose to start the therapy at home using the Gerson literature. The Gerson Institute is offering a non-medical telephone coaching service to assist people in using the Gerson literature to implement their program at home. Before or at the first coaching session, you will need to purchase the Gerson Therapy Home Package, which includes the following: 3 books: Healing the Gerson Way, A Cancer Therapy and the Gerson Therapy Handbook and set of 3 DVDs Vol. 1-3 for $125.00. You can purchase them online at: www.gerson.org/store or by calling the Gerson Institute at 619-685-5353. It is also important that you have the support of your family and a caregiver/helper to assist you in preparing the food and juices, etc. You will need a physician who is willing to order blood work and see you if the need arises. Please submit by mail or fax the following: · Application for the Coaching Program, page 2 · Summary for Coaching Session, page 4-6 · Medical Summary Form, page 7 · Recent CBC, (no more than 3 weeks old) · Recent Comprehensive Metabolic Profile · Lipid Profile · Thyroid tests (T4, TSH) · so that your coach can help you understand your results and self monitor your progress. Note: If your physician is not able to order these tests, you can use www.directlabs.com and ask for the Comprehensive Wellness Profile. To proceed with the coaching service, please complete the forms and return them along with your blood work by fax, email or regular mail to the Gerson Institute. Your case will be reviewed in terms of suitability for this service and you will be contacted within 2-5 days. There will be an initial fee of $270 which includes: · Open a file and case review time · Up to 30 minutes for the initial session · One year Membership to the Gerson Institute · Six issues of the bi-monthly publication Healing Newsletter · Books: A Cancer Therapy, Healing the Gerson Way, and Gerson Therapy Handbook · DVDs Workshop Vol. 1-3 If you already have the books and DVDs, then the initial fee will be $145. Subsequent follow up sessions will be $50 for up to 30 minutes. Please keep in mind that your coach is not a physician or a Gerson practitioner, but has extensive training and experience as a caregiver.
PO Box 161358
San Diego, CA 92176 - Phone (619) 685-5353
[email protected]
www.gerson.org
Fax (619) 685-5363
APPLICATION FOR THE COACHING PROGRAM (Non-medical Services) Please complete and return by mail or fax to the Gerson Institute along with the required documents. I would like to sign up for: $270 Coaching Program (if you don't have the books and DVD set yet) $145 Coaching Program (Please note this is a one-time fee.) Please check all that apply: I already have the books Healing The Gerson Way Book, Gerson Therapy Handbook and A Cancer Therapy
Yes
No
I already have the DVDs set Vol. 1-3
Yes
No
I have a basic understanding of the therapy
Yes
No
My family is supporting me in starting this therapy
Yes
No
I have someone to help me at home with the therapy (food prep and juicing)
Yes
No
Are you aware that we have qualified Home Set-up Trainers to help you set up your home and help you avoid mistakes? (see page 8)
Yes
No
Are you interested in receiving the list of Home Set-up Trainers so you can contact them?
Yes
No
I have a family physician that I can visit if the need arises
Yes
No
I understand the Coaching program is a non-medical advice service
Yes
No
I am including recent blood work
Yes
No
I understand there is a one time fee of $270 or $145 for the initial session
Yes
No
I understand that future sessions up to 30 minutes are $50
Yes
No
I understand coaching sessions are by telephone appointment only
Yes
No
I understand that e-mailed questions will be answered in the next session
Yes
No
I understand the Coaching service may be discontinued at any time by me or by the coach
Yes
No
Once we have received the required documents, a representative will contact you within 5 days in regard to your eligibility for this program. The payment method for this service is by credit card.
Name:
email: (as it appears on the credit card)
Tel.:
Cell: City:
Street Address: State/Province: Credit Card #: Signature
Country
ZIP/Postal Code: Exp. Date: Date
CVV:
Page 2 of 8
SUMMARY FOR COACHING SESSION Disclosure of non-medical services and clinic availability Please be informed that the Coaching Program is a non-medical service and to be under the care of a Gerson certified practitioner, the Mexican treatment center is recommended.
Date:
email:
Name:
Tel.:
1. Diagnosis:
2. Age: 4.Metastases:
3. Date of diagnosis: 5. Last blood test date: 6. Treated with chemotherapy?
Yes
No
7. Treated with radiation?
Yes
No
8. Basal Temperature:
Pulse:
9. Have you started the Gerson Therapy?
8 oz
Blood pressure:
Yes
How many juices a day do you drink? Volume of each juice:
Last date taken:
13
4 oz
If yes, when?
No
10
8
6
How many of each?: Carrot/Apple:
How many coffee enemas do you take daily?
5
4
3
Green:
2
Carrot:
Orange:
1
10. Please check all that apply and its dosage: Thyroid
Lugol's
1/2 grain
a day
1 grain
a day
9
6
4
3
2
1
drops/day
Pancreatin Liver caps
Acidol Potassium
tsp/juice
B12/Liver injection
CoQ10
Other
Niacin
Not taking anything yet
(frequency)
Page 3 of 8
11. Are you on another treatment?
12. Are you working right now?
Yes
Yes
No
No
If yes, which one?
If yes, how many hours?
hours/day
hours/week
What kind of work do you do? If not, are you planning to go back soon?
13. If on Gerson Therapy, are you following a:
Intensive protocol
Yes
No
Modified protocol
Other, describe:
14. Please describe your daily meals: Oatmeal
Breakfast
Orange juice
Yogurt
Fruits:
Rye bread
Honey
Apple sauce
Other
Notes: Hippocrates soup
Lunch
Salad
Cooked vegetables
Baked potato
Rye bread
Dessert
Other
Yogurt
Notes: Hippocrates soup
Dinner
Salad
Yogurt
Cooked vegetables
Baked potato
Rye bread
Dessert
Other
Notes:
15. Do you have an organic food supply?
Yes
No
Is there any food that you cannot get organic? Who is your produce provider?
16. Do you have a food mill?
Yes
No
Page 4 of 8
17. What kind of juicer do you use?
Norwalk juicer
Centrifugal
Champion + hand operated press
Other
18. How many coffee enemas do you take daily? Are you able to hold it for 12-15 minutes?
Yes
No
Yes
No
Sometimes
Any other difficulties with enemas?
19. Do you need help to order the supplements?
20. What was your previous diet? Please describe
21. Do you have someone to help you with juices and meals? 22. Do you have
Family support?
Yes
No
Spouse
Son/Daughter
Other
Hired help
Parents
Neighbor
Opposition?
23. Please describe symptoms or current problems
24. Are you experiencing any of the following symptoms? Flu like symptoms
Nausea
Strange skin odor
Headaches
Pain
Ulcers
Anger Lost of appetite
Symptoms of old injury Mucous
Dizziness
Cold sores
Sweats
Chemotherapy reactions
Where?
Fluid retention/edema Other
Mood swing
Where?
Please describe:
Page 5 of 8
25. Are you using the clay pack treatment?
Yes Yes
26. Are you using the castor oil pack treatment? 27. Are you using aloe vera juice?
Yes
28. Is there fluoride in your water supply?
No No
No Yes
No
Don't know
29. Please mark all that apply. Sources of toxins that you are exposed to: Cell phone towers
Chemicals
Power lines
Microwave
Cosmetics
Fluoride
Dental mercury amalgams
Pesticides/Herbicides Prescription/recreational drugs
Root canals Other sources:
30. Do you smoke?
Yes
No
Do you drink alcohol?
Yes
No
31. Do you have a specific topic or question you want to discuss? If yes, please list them below:
Page 6 of 8
COACHING SERVICE - MEDICAL SUMMARY FORM First Name:
Middle Initial:
Last Name: City:
Street Address: State/Province:
ZIP Code:
Home Phone
Country
Work Phone
Cell Phone
email:
Spouse Name:
Alternative person to call: How did you hear about us? Female Male
Phone:
Relation to patient:
Friend/Relative
Doctor
Internet
Gerson documentary
Patient
Book
Age:
Date of Birth:
Languages you speak:
ft
Height:
m
MM/DD/YYYY
lb
Weight:
kg
Can patient eat and drink?
Yes
No Is the patient bedridden?
Yes
No
Is the patient able to walk?
Yes
No
Can patient eliminate?
Yes
No Is the patient constipated?
Yes
No
Patient requires a wheelchair
Yes
No
Is the patient on dialysis?
Yes
No Fluid in lungs/chest cavity?
Yes
No
Fluid retention in abdomen?
Yes
Patient requires oxygen
Yes
No
If yes, was fluid removed?
Yes
No
If yes, was fluid removed?
Yes
Did patient have a colostomy?
Yes
No Any external or internal bleeding?
Did patient have a ileostomy?
Yes
No History of mental/emotional illnesses?
Yes
No Location: Yes
Current Diagnosis:
Date of diagnosis: Primary tumor site:
Describe any metastases: Stage of diagnosis:
Type of cancer: Chemotherapy use?
Yes
Radiation use?
No Date of last treatment:
Yes
Yes
No
Was there any recurrence after treatment?
Yes
Hormone Therapy:
No
No Date started : Date : Date :
Location: Asthma
Clotting problems
Hepatitis
Yes
Description:
Complicating factors or symptoms (check all that apply): Epilepsy
Grade of diagnosis:
Date of last treatment:
If yes, how many cycles?
No
Surgeries within the past 5 years?
Diabetes
No
High blood pressure
Pneumonia
Arthritis
Nausea/Vomiting
Trouble breathing
Heart condition
Other
Current medications other than Gerson supplements? Energy level:
None
Low
Medium
High
Pain level:
None
Low
Medium
High
Does patient have any foreign bodies? IV access port
Date:
Root canal
Abdominal teflon mesh
Taking pain medication? Heart valve
Biliary stent
IUD
Yes
Steel plates/screws
No Breast implants (
Coronary stent - When placed?
Patient's Signature :
Saline
Silicone )
Certified Gerson Home Set-up Trainer A Certified Home Set-up Trainer is fully trained by the Gerson Institute in all of the non-medical aspects of the Gerson Therapy. This includes helping and teaching you to prepare the Gerson meals and juices, explaining the coffee enema technique, providing information on healing reactions, and supporting you in various non-medical ways unique to your situation. It is easy to make a mistake when making the Gerson foods and juices and doing the Gerson Therapy. And people often do not realize what they do not know. For this reason, Home Set up Trainers provide an excellent service that can greatly help you implement your personalized treatment plan. Their job is to go to your home to help them prepare your home environment for starting the Gerson Therapy by: ·
Assisting and teaching you valuable information regarding home set up and correctly making the Gerson foods and juices
·
Teaching you how to avoid mistakes
·
Organizing the kitchen and equipment, making the long work day “easier to accomplish.”
·
Providing Gerson-approved resources and information for obtaining safe, pure water in the home and all other Gerson equipment
·
Helping you to acquire a proper juicer before arriving in the home, and teaching you how to prepare the juices
·
Addressing the issue of possible toxins in and around the home
·
Locating sources for organic foods, if needed
The Gerson Home Set-up Trainer also provides support by: ·
Training someone in the home that will continue to assist you with the work
·
Providing information on contacting supplement companies
·
Assisting you in finding information in the Gerson educational materials (books, DVD's, etc.)
·
Explaining and demonstrating the coffee enema preparation technique, and the castor oil treatment (if applicable)
·
Providing information on healing reactions.
·
Gerson Home Set-up Trainers are not medical professionals, so they do not provide medical advice or prescribe individualized treatment protocols.
·
Gerson Home Set-up Trainers are not employees of the Gerson Institute, they are independent contractors, and set their own rates. The average fee is $200 per day for a 10 hour work day.
·
3-4 days is the recommended terms for a Gerson Home Set-up Trainer's services
·
Some Home Set-up Trainers are willing to travel to a different city or even country, and others prefer to work locally.
·
Gerson Home Set-up Trainers work exclusively in clients' homes - they not give consultations, information, or advice by phone, email or Skype. If you have questions pertaining to the Gerson Therapy, please contact the Gerson Institute's Education Department.
·
The Home Set-up Trainers and Coaching Service work well together to help you get started on the Therapy.
