OPTIMAL WELLNESS NATURAL HEALTH CENTER
INFORMED CONSENT
TELEPHONE NUTRITIONAL CONSULTATION SERVICES
I specifically authorize the natural health practitioners at Optimal Wellness Natural Health Center to develop a natural, complementary health improvement program for me which may include dietary guidelines, nutritional supplements, and other natural programs.
- I understand that consultations, podcasts, and programs are not intended to diagnose, treat, cure, or prevent any disease including conditions of cancer, Aids, infections, or other medical conditions and that these are not being tested for or treated.
- I understand that no guarantee or assurance of any specific result is given or implied.
- I understand that consultations, products, and programs do not supplant competent medical care and that regular medical examinations for the early detections of disease are important
- I understand that statements regarding consultations, products or programs have not been evaluated by the FDA
- I understand that the practitioners at Optimal Wellness Natural Health Center encourage me to consult with a medical doctor before starting, stopping, increasing, or decreasing prescription medication.
A HEALTHY LIFESTYLE
Our program is designed to help you establish a healthier lifestyle. Recommendations include nutritional supplements, food selection, exercise, and stress reduction. Results depend on the earnest implementation of these recommendations. It often takes six to nine months to establish new healthful lifestyle patterns.
RISKS ASSOCIATED WITH TELEPHONE NUTRITIONAL CONSULTATION SERVICES
- When taken at recommended dosages nutritional supplements are generally recognized as safe. Occasionally one may experience temporary digestive upset or a temporary allergic reaction. Because you have not been physically examined the practitioner has less information, for that reason you are encouraged to have periodic medical checkups especially if you have persistent symptoms, recurrent symptoms or if you do not seem to be responding to the recommended nutritional program.
AVAILABILITY AND NATURE OF OTHER OPTIONS
- Some patients have asked if they can consult with our office and purchase supplements elsewhere. This is not recommended because we cannot be sure of the quality or freshness of the supplements; there are also reports of fraudulent supplements sold on the internet. If a patient insists on getting supplements elsewhere the charge of an office visit is $75, as it is more difficult to get results.
PAYMENT FOR SERVICES AND PRODUCTS
- Wellness Services and products are not covered by any insurance plan. Insurance Plans deal with injuries and illnesses.
- All fees for services and nutritional supplements are dues prior to delivery. This is to keep you
- Informed of charges before they are incurred and to provide faster service. There will be a 20% restocking fee, no exceptions.
- We require a 24hr. Notice of cancellation or rescheduling.
- The patient may terminate care at any time
CONSENT
I have discussed any questions I have with the Healthcare Practitioner and have had my questions answered to my satisfaction. By signing below, I state that I have weighed the risks and benefits of Telephone Nutritional Consultations and related programs and have decided that is in my best interest to participate in this Nutritional Consultation program and give my consent.