NATUROPATHY

NEW PATIENT FORM

Please complete the New Patient Form prior to your appointment. Click submit when you have completed all information. 

 INTOUCH HEALTH CO. - NEW PATIENT FORM
Naturopathy
Title

Patient Information and Consent Form
 

Consent

I have been truthful, concise and disclosed correct details in regards to my present and past state of health. If any of these details do change in the future, it is my responsibility to update the treating practitioner at the time. 

 

This consent form will cover the entire course of treatment for my present condition, and for any other future condition(s) for which I seek treatment. I understand that I can withdraw my consent at any time.

 

Duty of Disclosure

In the best interest of the client’s health, it is the client’s responsibility & obligation to notify (all of) their health practitioner/s of any changes to their situation (e.g., medications, personal details, symptomatology, examinatory testing, etc.). 

 

It is the client’s responsibility & obligation to keep their medical doctor/s and/or specialist/s informed of any consultation/s with your Naturopath, including any supplementation or other recommendations made during consultations and / or treatment, as this may change the nature of any past, current or future medical (or other health-related) recommendations that may be made to them. Furthermore, it is the client’s responsibility & obligation to keep your Naturopath informed of any consultation/s with medical doctor/s and/or specialist.

 

At times it may be necessary for your Naturopath to contact the client’s medical doctor/s, specialist/s, and/or other health professional/s as required, or if requested by the client. However, contact with medical doctor/s and/or specialist/s will not necessarily be automatic.     

 

Payments
The services offered by your Naturopath are provided on a serviced based fee, Fees are currently set at $140.00 for Initial Consultations and $99 for Follow Up Appointments. This fee is payable at the time of consultation either by cash, credit, or EFTPOS. Rebates may be available through your private heath fund. HICAPS facilities are available. 

 

Cancellation Fees
If you cannot attend your appointment, please notify your naturopath as soon as possible. Appointments cancelled without at least 24 hours notice are charged at the full fee.

 

I acknowledge that I am aware of, and understand the potential risks of Naturopathic treatment. I am also aware and understand that results cannot be guaranteed. Through the consult and treatment I also have the opportunity to ask questions about the nature, extent and purpose of the proposed care, and that I have been given sufficient time to make a decision giving the consent for the care to proceed.

Patient Signature

Parent Signature (if patient is under 18)

Shop 16, 1 Raintree Way

Mount Annan, 2567

T: 02 4648 3500

F: 02 4648 5200

E: admin@intouchosteo.com.au

 

Shop 16, 1 Raintree Way

Mount Annan, 2567

T: 02 4648 3500

F: 02 4648 5200

E: admin@intouchosteo.com.au

 

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