If you desire to request a refund for any reason.
Please fulfill the following requirements

Step 1:
– Request –
Options include an email, text or written letter.
Request includes the information
from page two, below,
or use this printable document 

Step 2:
– Acknowledge –
You will receive a response back that the
message was received in the same manner
in which the request was sent

Step 3:
– Description –
Please provide details for reason of early
stoppage of care prior to completion of the
agreed upon terms of the package purchased

Step 4:
– Refund –
Refund will be supplied between
10 and 30 business days
up to $500 per 30 day period


Get Printable Version Of Document Here



——- Photo & Message, Copy & Paste or Print & Send Below, Submit With Your Request——-




By submitting request for refund mid-care, I ________________________________:

(Print Your Name Clearly)



Attest to the following;
I performed self assessment of the following; Why care was sought initially? What was initially expected prior to contacting Dr Kevin from Dr Kevin’s services? What was experienced upon initial contact with Dr Kevin? What was agreed upon? What was experienced? and what is desired for the future care of the concerns initially sought?


  • I gave full attention to address my health concerns and wellness naturally via Dr. Kevin Gyurina’s recommendations and guidance based on agreed upon terms.
  • I was made aware and provide informed consent to experience the doctors vision for my health care, regardless of novelty of technique, method or application of method to my current level of awareness, insight or experience of methods and technologies provided.
  • You took action to contact the doctor  with any questions, problems, concerns, etc regarding your care or direction of care


Signed by: ________________________________________
(signature here)


Print Name: _______________________________
(Print Your Name Clearly)


Date Signed: _________________



——- for official purposes only below here ——-

Date Received:

Date Fulfilled:

Signed Complete By:

Date Confirmed Complete: