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    Naturopathic Medicine Treatment Consent Form

    Uploaded by

    Gilbert Ezengige
    This document is a naturopathic medicine treatment consent form filled out by a patient. It contains the following key points: 1) The patient takes sole responsibility for following the treatment advice of Dr. [Name] and authorizes treatments like naturopathy, homeopathy, acupuncture, and others. 2) The risks, alternative treatments, and potential complications will be explained by the doctor. 3) The patient acknowledges that results cannot be guaranteed and agrees to comply with recommended therapies. 4) Care may be provided by an associate doctor without another consent if the regular naturopath is unavailable.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Naturopathic Medicine Treatment Consent Form

    Uploaded by

    Gilbert Ezengige
    288 views1 page
    This document is a naturopathic medicine treatment consent form filled out by a patient. It contains the following key points: 1) The patient takes sole responsibility for following the treatment advice of Dr. [Name] and authorizes treatments like naturopathy, homeopathy, acupuncture, and others. 2) The risks, alternative treatments, and potential complications will be explained by the doctor. 3) The patient acknowledges that results cannot be guaranteed and agrees to comply with recommended therapies. 4) Care may be provided by an associate doctor without another consent if the regular naturopath is unavailable.

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    Naturopathic Medicine Treatment Consent Form

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    This document is a naturopathic medicine treatment consent form filled out by a patient. It contains the following key points: 1) The patient takes sole responsibility for following the treatment advice of Dr. [Name] and authorizes treatments like naturopathy, homeopathy, acupuncture, and others. 2) The risks, alternative treatments, and potential complications will be explained by the doctor. 3) The patient acknowledges that results cannot be guaranteed and agrees to comply with recommended therapies. 4) Care may be provided by an associate doctor without another consent if the regular naturopath is unavailable.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    288 views1 page

    Naturopathic Medicine Treatment Consent Form

    Uploaded by

    Gilbert Ezengige
    This document is a naturopathic medicine treatment consent form filled out by a patient. It contains the following key points: 1) The patient takes sole responsibility for following the treatment advice of Dr. [Name] and authorizes treatments like naturopathy, homeopathy, acupuncture, and others. 2) The risks, alternative treatments, and potential complications will be explained by the doctor. 3) The patient acknowledges that results cannot be guaranteed and agrees to comply with recommended therapies. 4) Care may be provided by an associate doctor without another consent if the regular naturopath is unavailable.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Naturopathic Medicine Treatment Consent Form

    (Filled by the patient or guardian)

    First Name: _________________________ Last Name: ___________________________________

    Home Address: _________________________________________________ Tel:


    ____________________ Date of Birth: _____________ Age: _______ Occupation:
    _________________________________

    Email Address: ____________________________

    Naturopathic Medicine is a form of natural medicine.


    1. I take sole responsibility for my consent to follow the advice and treatment suggested
    by Dr______________
    2. I authorize Dr.________________ to perform the following procedure(s) and treatment:
    -Naturopathy, Homeopathy, Acupuncture, Hydrotherapy, Nutritional Counseling,
    Detoxification, Herbs, Physical and Lifestyle counseling or any other natural treatment
    that he considers advisable in his opinion, judgement and conclusion.
    3. The nature and purpose of the treatment, possible methods of treatment, alternate
    methods of treatment, the risks involved and the complications will be fully explained to
    me by the above named doctor and or their associates and or assistants.
    4. It is my responsibility to comply with the therapies recommended.
    5. I acknowledge that no guarantee or assurance has been made to me as to the results
    that may be obtained
    6. I understand that when my regular Naturopath is unable to attend to me, my care may
    be administered by an associate Doctor of Naturopathy, without another consent being
    prepared.
    Note: medical records will not be released without your written consent
    No refunds on services rendered and remedies supplied.
    I certify that I have read and fully understood the above consent to treatment and that this
    form was completed prior to treatment and signed by me without duress.
    Signature of Patient: __________Date: ________
    Signature of Witness _______ Date: _________
    Note: when the patient is a minor or otherwise incompetent to give consent, the consent of a
    parent or guardian must be obtained.
    Signature of Parent or Guardian: ______________________
    Name of Signatory: ________________________ Date _________________

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