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BE NATURALLY HEALTHY LIMITED INFORMATION FORM (CONFIDENTIAL)
Statement of Acknowledgement and Informed Consent to Naturopathic Nutrition and Lifestyle Medicine with Be Naturally Healthy Limited
Naturopathic Nutrition and Lifestyle Medicine is practiced by non-medical professionals and is complimentary to other regulated forms of healthcare in England.
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 measure could be taken, and specific lab diagnostic tests may be required by other health care practitioners you have/are seeing or through private testing laboratories.
While the best course of action is continually sought for the client there always exists the possibility of side effects, adverse reactions or inefficacy of treatment. Be Naturally Healthy Limited holds your safety and well-being as top priority in the management of your case and welcomes all questions or concerns you may have.
By signing the statement of acknowledgement, you understand that:
Register Nutritional Therapist:
- Naturopathic Nutrition and Lifestyle Medicine is not a substitute for professional medical advice and a Registered Nutritional Therapist is not a conventional medical doctor (GP).
- Naturopathic Nutrition and Lifestyle Medicine advice will be tailored to support medically diagnosed conditions and/or health concerns agreed and identified by the two parties.
- Registered Nutritional Therapists are not permitted to diagnose or claim to treat medical conditions.
- Be Naturally Healthy Limited reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended.
- You are ultimately responsible for your health care, Be Naturally Healthy Limited are here to support you but reserve the right to discontinue services where it is apparent that your expectations of what can be provided are not in agreement.
You (the client) understand and agree that:
- Be Naturally Healthy Limited has in no way suggested that being under their care should prevent me from seeking treatment from any other healthcare practitioner.
- Be Naturally Healthy Limited will strive to deliver the safest and most effective interventions for my case, however there is still the possibility that side effects or adverse reactions might occur, or that therapeutic benefit may not be achieved.
- I will inform Be Naturally Healthy Limited of all medical conditions I have been diagnosed with, symptoms I am experiencing, and medications or supplements I am taking/have taken in the past. I will also inform them of any new medical conditions or symptoms or medications should they arise.
- I will inform Be Naturally Healthy Limited if I am pregnant or breastfeeding. I will immediately inform should I become, or plan to become pregnant or if I begin, or plan to begin to breastfeed.
- I will inform Be Naturally Healthy Limited if I do not understand any given part of the recommendations given to me or if I am uncomfortable with any aspect of my care.
- All of the information I provide to Be Naturally Healthy Limited is protected by General Data Protection Regulations and is confidential unless disclosure is required by law.
- My case information may be used for the publication of case reports or case studies. Any information concerning my identity will be excluded from publication, thus maintaining my anonymity.
- I am free to purchase any products recommended by Be Naturally Healthy Limited for my treatment from a vendor of my choosing, being under no obligation to purchase products from Be Naturally Healthy Limited directly.
- I understand that all services are payable in advance and bookings are not confirmed until receipt of payment. There may be additional costs for supplements and laboratory testing which will be optional and discussed with Be Naturally Healthy Limited during the consultation.
- I understand that 72 hours notice period is required if I wish to cancel an appointment and receive a full refund. If less than 72 hours notice is provided, Be Naturally Healthy Limited reserves the right to charge 50% of the full cost of the appointment. Rescheduling more than once may incur a fee and will be at the discretion of Be Naturally Healthy Limited.
I, the undersigned, declare that I have read and understood the information presented above and that I authorise and consent to my present and future use of the Naturopathic Nutritional and Lifestyle Medicine services by Be Naturally Healthy Limited. I understand that I may withdraw this consent at any time.