Consent Form Alternative

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Consent Form for Medical Intuitive Exam and Services:

I understand that no warranty or guarantee has been made to me as to result of care. I also realize that there are no “double-blind studies” that have been written up regarding this Medical Intuitive exam and my condition. 

I understand and realize there may be risks and hazards in continuing my present condition without conventional medical treatment, but I am choosing to listen, understand and incorporate alternatives in eating habits, supplement programs or lifestyle changes that I feel will benefit my health and current condition. 

I am connecting with Dr. Moffat in an attempt to learn health information for myself or my pet to which I am the legal owner of. 

I understand that good communication is essential in learning any new techniques and ideas and I commit to ask clarifying questions and seek understanding when I feel it is necessary. 

I have permission and am willing to ask questions about my condition, conventional treatments, integrative and complementary treatment protocols, alternative forms of treatment, possible risks of treatment and non-treatment, procedures to be used, and the risks and hazards involved. 

I also understand that it is not the intent of Dr. Denice Moffat to diagnose or prescribe. We are here to receive health information. In the event that I use this information without my doctor’s approval, I am prescribing for myself, which is my constitutional right. 

I will work with my medical doctor if I decide to discontinue use of any medications. 

I will contact Dr. Moffat while I am in her care if I add nutritional supplements and medications to her recommendations or I understand that her contract with me is invalidated and that she is not to be held responsible for that outcome. 

It is my responsibility to bring up questions and problems I may have during the time I contract with Dr. Moffat for advice and guidance. 

I believe that I have sufficient information to give this informed consent before continuing and that I am comfortable in knowing that I have the ultimate say as to how I will proceed. 

I have read this entire form and I understand its contents. 

X___________________________________________  Date: _________

 Dr Moffat’s Intentions for You:

To give you the best advice I have to give and in the learning modality that you feel you need to understand the information. 

To keep the lines of communication open to further your education and empower you to make better health choices. 

To make myself available through email (first choice and best way) or phone to answer questions that may come up. 

To understand that I do not know you well enough to be able to evaluate how much medical information you know, your intuition and ability to listen to your own body and how you are interpreting the information I give you orally and in writing. Please do not think that I would have judgement of you for asking the same question twice. We need to help you to understand our recommendations so that you can accomplish your goal of health. If you don’t understand, that won’t happen. We are happy to keep at the process until you “get it” if necessary. 

To understand that everyone comes to me with various levels of experience and understanding in the alternative and complementary areas. It is sometimes impossible to convey all that I need to my clients in a 60-90 minute period. Where I see the need for you to understand more, I will recommend or send home reading material or other forms of education. I feel it is important for you to follow up with that information. I am always willing to give you titles of resources that may help you. Please ask me for them. 

I will not knowingly take financial advantage of you or sell you items that are unnecessary for your condition. 

I will refer you to other practitioners and professionals for those areas I feel I am not qualified to address. 

I, Dr. Denice Moffat can assume no responsibility for your health because of all the variables discussed in this document, but we are happy to guide and coach you in any way we can. 

These are my intentions for you.                            Date: __________

Signed: _______________________________________________