Every patient is required to read and agree to this form before your first treatment. By ticking the “I have read and understand Naturopathic Informed Consent” check box you are acknowledging the following: Naturopathic medicine is the use of gentle, non-invasive treatments and prevention of disease by natural means. Naturopathic doctors assess the whole person, taking into consideration physical, mental and emotional aspects of the individual. Deborah Gibson, Naturopath will take a thorough case history, may perform a physical exam and may suggest specific diagnostic testing in addition to treatment recommendations.

It is very important that you inform your Naturopath immediately of any diagnoses that you have received from other licensed health care providers and any prescribed or over the counter medications that you are currently taking. Please also advise your Naturopath if you are pregnant, suspect you are pregnant or if you are breast-feeding.

I understand:

• Some patients may experience allergic reactions to certain supplements and herbs. Please advise your Naturopath of any allergies that you may have
• As with all medical therapies the clinic does not guarantee results, Naturopathic medicine has its limitations and may not be able to treat all conditions
• That my Naturopath will explain the nature of my treatment and will answer any questions that I may have
• I am free to withdraw my consent and to discontinue treatment at any time
• That Naturopathic medicine can work in conjunction with other forms of therapy and need not be considered exclusively beneficial. I do not need to choose one form of treatment over the other.
• That expenses for Naturopathic care are not covered under provincial health care. Naturopathic expenses may be tax deductible or covered by extended health care benefit plans. Please check with your insurance provider for coverage.
• Natural health care is a joint responsibility between myself (the patient) and my practitioner.Improving my lifestyle can be as important as the therapies and treatments provided by the clinic. I am willing to be an active participant in my wellness.
• My health records may be used in research providing that my name or any identifying information is not revealed. At all other times, my health records will be held in strictest confidence.
• That Naturopathic medicine is not an isolated system and that you Naturopath welcome’s teamwork with other practitioners.
• I understand that the decision to discontinue prescription medications or any other prescribed medical treatment is my own responsibility. If I forego standard medical treatment in favor of natural therapies, I assume responsibility for any potential risk that may entail. Your Naturopath will explain procedures, probably outcomes and possible risks whenever possible.