Statement of Acknowledgement and Informed consent to Examination and compilation of protocol.
This form must be signed before our consultation can commence.
I utilise the principles and practices of Naturopathic medicine and other supportive therapies to assist the body’s own ability to heal and to improve the quality of like and health through natural means. Naturopathy and Naturopathic nutrition assess the whole person, assessing mental, emotional and physical health. During your visit, a thorough health history will be taken and, if needed, examination such as hip to waist measurements (no clothes need to be removed), blood pressure monitored, weight may be taken, and specific lab diagnostic tests may be advised by other health care practitioners you have/are seeing or through private testing laboratories.
By signing this statement of acknowledgment, you understand that:
Nutritional Therapy Consultation Disclaimer
I am a Naturopath/Naturopathic nutritionist and NOT a conventional medical doctor (GP). Any advice you receive is not mutually exclusive from any treatment or advice you may now be receiving or may receive in the future from any other licensed health care practitioner.
The methods I may use have a proven clinical foundation, yet may not be recognised or accepted by standard (allopathic) medicine.
The advice and/or referral to other health care practitioners is based on the assessment of your health, revealed through personal history, examination, laboratory testing, and any other appropriate method of evaluation.
I reserve the right to determine which cases fall outside my scope of practice, in which event the appropriate referral will be recommended.
You are not an agent of any private or government agency attempting to gather information without so stating your intentions.
Changes in dietary habits are not an absolute prerequisite for treatment and you understand that failure to follow sound nutritional, exercise and lifestyle programs could undermine any expected results.
You are accepting or rejecting this care of your own free will.
The ultimate responsibility for your health care is your own and that I am here to support you in this. I reserve the right to discontinue my services where it is apparent that your expectations and what I can provide are not in agreement.
Understanding that all fees are payable at the time of appointment by the client or the guardian. Notice of 24 hours is required for appointment cancellations, otherwise you will be charged an administration fee of £45.00.
I also recognise that even the gentlest therapies, supplements and medications potentially have their complications in certain physiological conditions, in very young children, in those on multiple medications, in pregnancy, while breastfeeding and hence the information provided is complete and inclusive of all health concerns including risk of pregnancy; all medications, including over the counter drugs and supplements. The slight health risk of some Naturopathic treatments include, but not limited to; aggravation of pre-existing symptoms, allergic reaction to supplements or herbs; pain, fainting, bruising or injury from acupuncture.
Due to the new GDPR regulations, I am legally obliged to store your personal data securely. Your data will be held offline and locked securely. After 7 years, your data will be destroyed unless it is required for any medical or legal reasons.
Your personal data will never be used for marketing purposes or used for anything other than to contact you or share with another medical or legal body after you have given consent where applicable.
Should you wish to receive marketing material from me, usually a monthly blog or article about the various information on the latest news in the Nutrition industry, please tick so in the client intake form.
You are entitled to request a copy of your data and be removed from any marketing mailing lists as and when you require to do so.
Note: A copy of the terms and conditions will be emailed to you for signing when you make your booking.
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