REGISTRATION FOR Online Nutrition Program

Online Nutrition Program And Supplement Sales Agreement

I request that I be allowed to participate in Dr. Lori Puskar’s “Online Nutrition Program”, a program which allows Dr. Lori Puskar to supply general nutrition not related to nor for the handling of any health symptoms, conditions, diagnosis, and/or to treat or cure any illness or disease; and for me to purchase supplements online and be in control of my own nutrition and supplements.  

I understand that no guarantee is made in this program regarding my nutrition or health including any recommendation, statement, article, employee, educational media/material from Dr. Lori Puskar. I will not hold, Lori Puskar, DC, her LLC, or any of its direct or indirect; associates, affiliates, representatives and/or vendors, liable for any situation regarding my body, health, nutrition or any purchase from Dr. Lori Puskar.

I understand that my information will be kept secure in keeping with Dr. Lori Puskar’s PRIVACY POLICY & HIPPA STATEMENT and that I agree to Dr. Puskar’s full disclaimer at

I have read and understand the foregoing and agree that by filling out and electronically signing the form below, this gives my consent and applies to all previous paragraphs and any/all previous and future interactions with Dr. Lori Puskar of any kind.

Please Provide Your Information

Now that you have registered, let's get  you set up for your $69 Trial Membership.

 (Regularly $99)  

Make sure to download the attached forms.

Include any blood, labs or DNA results you have.

Return to us at: