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, e-mail 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.

Coaching Service Program

PO Box 161358 San Diego, CA 92176 - Phone (619) 685-5353 Fax (619) 685-5363 info@gerson.org www.gerson.org

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 I already have the DVDs set Vol. 1-3 I have a basic understanding of the therapy My family is supporting me in starting this therapy I have someone to help me at home with the therapy (food prep and juicing) 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) Are you interested in receiving the list of Home Set-up Trainers so you can contact them? I have a family physician that I can visit if the need arises I understand the Coaching program is a non-medical advice service I am including recent blood work I understand there is a one time fee of $270 or $145 for the initial session I understand that future sessions up to 30 minutes are $50 I understand coaching sessions are by telephone appointment only I understand that e-mailed questions will be answered in the next session I understand the Coaching service may be discontinued at any time by me or by the coach 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.

NoYes

NoYes

NoYes

NoYes

NoYes

NoYes

NoYes

NoYes

CountryZIP/Postal Code:State/Province:

City:Street Address:

Tel.:

Name: email:

Cell:

Credit Card #: Exp. Date: CVV:

(as it appears on the credit card)

Signature DatePage 2 of 8

NoYes

Yes No

Yes No

Yes No

Yes No

NoYes

NoYes

Date:

Tel.:Name:

4.Metastases:

1. Diagnosis:

3. Date of diagnosis:

NoYes6. Treated with chemotherapy?

Page 3 of 8

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.

SUMMARY FOR COACHING SESSION

email:

2. Age:

5. Last blood test date:

Last date taken:

Yes No7. Treated with radiation?

Blood pressure:8. Basal Temperature: Pulse:

If yes, when? NoYes9. Have you started the Gerson Therapy?

4 oz8 ozVolume of each juice: Orange:Carrot:Green:Carrot/Apple:

How many juices a day do you drink?

How many coffee enemas do you take daily? 5 4 3 2 1

681013

How many of each?:

(frequency)

10. Please check all that apply and its dosage:

Potassium

Acidol

CoQ10

Lugol's

Niacin

Pancreatin

Thyroid

Liver caps

B12/Liver injection

Other

drops/day

tsp/juice

1/2 grain a day

a day1 grain

Not taking anything yet

469 123

14. Please describe your daily meals:

Page 4 of 8

Is there any food that you cannot get organic?

15. Do you have an organic food supply?

Who is your produce provider?

NoYes

Other, describe:

Modified protocolIntensive protocol13. If on Gerson Therapy, are you following a:

NoYes16. Do you have a food mill?

Breakfast Fruits: Other

Oatmeal Orange juiceYogurt Rye bread Honey Apple sauce

Notes:

Lunch OtherSalad Yogurt

Hippocrates soup Cooked vegetables Baked potato Rye bread Dessert

Notes:

Dinner Other

Baked potato

Salad

Hippocrates soup Cooked vegetables

Yogurt

DessertRye bread

Notes:

NoYes11. Are you on another treatment? If yes, which one?

12. Are you working right now? If yes, how many hours? hours/day NoYes hours/week

If not, are you planning to go back soon? NoYes

What kind of work do you do?

Page 5 of 8

20. What was your previous diet? Please describe

17. What kind of juicer do you use?

Champion + hand operated press

Norwalk juicer

Other

Centrifugal

Are you able to hold it for 12-15 minutes?

18. How many coffee enemas do you take daily?

Yes No Sometimes

NoYes19. Do you need help to order the supplements?

Any other difficulties with enemas?

Please describe:

Where?

Where?

Sweats

Chemotherapy reactions

Nausea

Pain

Flu like symptoms Mood swing Anger

Fluid retention/edema

24. Are you experiencing any of the following symptoms?

Symptoms of old injury Cold sores

HeadachesStrange skin odor Ulcers Mucous Dizziness

Other

Lost of appetite

Son/Daughter

Parents21. Do you have someone to help you with juices and meals? Yes No Spouse

Hired help Neighbor

Other

23. Please describe symptoms or current problems

Opposition?Family support?22. Do you have

NoYes25. Are you using the clay pack treatment?

NoYes26. Are you using the castor oil pack treatment?

NoYes27. Are you using aloe vera juice?

NoYes28. Is there fluoride in your water supply?

ChemicalsCell phone towers Cosmetics Fluoride

29. Please mark all that apply. Sources of toxins that you are exposed to:

Pesticides/Herbicides

MicrowavePower lines Prescription/recreational drugsDental mercury amalgams

Other sources:

NoYes30. Do you smoke? Do you drink alcohol? NoYes

31. Do you have a specific topic or question you want to discuss? If yes, please list them below:

Page 6 of 8

Don't know

Root canals

First Name: Last Name:Middle Initial:

Street Address: City:

State/Province: ZIP Code:

email: Spouse Name:

Alternative person to call: Relation to patient: Phone:

Friend/Relative InternetDoctor Languages you speak:

COACHING SERVICE - MEDICAL SUMMARY FORM

Country

Home Phone Work Phone Cell Phone

Patient BookGerson documentary

Female

MaleAge: Date of Birth:

MM/DD/YYYY

Height:ft

m

lb

kgWeight:

Can patient eat and drink?

Can patient eliminate?

Yes No

Yes No Is the patient constipated?

Yes No

Yes No

Is the patient able to walk?

Patient requires a wheelchair

Yes

Yes

Is the patient on dialysis?

Patient requires oxygen

Yes No

Yes No

Fluid in lungs/chest cavity?

If yes, was fluid removed?

Yes No

Yes No

Fluid retention in abdomen?

If yes, was fluid removed?

Yes

Yes

NoDid patient have a colostomy? Yes

NoDid patient have a ileostomy? Yes

NoAny external or internal bleeding? Yes Location:

Current Diagnosis: Date of diagnosis:

Describe any metastases: Primary tumor site:

Stage of diagnosis: Grade of diagnosis: Type of cancer:

If yes, how many cycles?NoChemotherapy use? Yes Date of last treatment:

NoRadiation use? Yes Date of last treatment: NoHormone Therapy: Yes Date started :

NoYesHistory of mental/emotional illnesses?

Surgeries within the past 5 years? Yes No Description: Date :

Was there any recurrence after treatment? Yes No Location: Date :

Is the patient bedridden?

Date:

Complicating factors or symptoms (check all that apply):

Diabetes

Heart condition

PneumoniaHepatitisEpilepsy Arthritis

High blood pressureAsthma

Trouble breathing

Nausea/Vomiting

Clotting problems

Current medications other than Gerson supplements?

Energy level:

Pain level: Taking pain medication? Yes No

IV access port

Root canal

Coronary stent - When placed?

Steel plates/screwsHeart valve Breast implants ( )

Biliary stentAbdominal teflon mesh

Does patient have any foreign bodies?

Patient's Signature :

IUD

Saline Silicone

Other

None Low Medium High

None Low Medium High

How did you hear about us?

No

No

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.