INFORMED CONSENT FORM FOR NUTRITIONAL CONSULTING
I am employing the consulting services of Patricia Daly so that I can obtain information and guidance about health factors within my own control: my diet, nutrition and lifestyle. By optimizing these factors, I believe I can nourish and support my health and well-being.
I understand that Patricia Daly is a Nutritional Therapist— not a medical professional— and does not dispense medical advice nor prescribe treatment. Rather, she provides education to enhance my knowledge of health through the use of whole foods and appropriate dietary supplements. While nutritional and botanical support can be an important complement to my medical care, I understand these services are not a substitute for medical care and are not intended for the diagnosis, treatment, alleviation or cure of disease.
Methods of nutritional evaluation or testing made available to me are not intended to diagnose disease. Rather, these assessment tests are intended as a guide to developing an appropriate health-supportive programme for me, and to monitor my progress in achieving my health goals.
Medical records and personal information supplied to Patricia Daly will be kept strictly confidential.
Please download and fill in the ‘Terms of Engagement’ form. You can use the ‘fill & sign’ option to add your signature into the pdf. This form can then be saved and emailed to Patricia Daly prior to your consultation.