Doctor Nature Healing | Ayurvedic Consults                            

 

DISCLOSURE AND RELEASE AND WAIVER OF LIABILITY AGREEMENT

 

I, the undersigned (client), acknowledge that I have read and understood the contents of this agreement.

 

1. Doctor Nature Healing, Doctor Nature, the founders and employees of Doctor Nature Healing and its sister company(ies) make no representations, claims, or guarantees regarding the efficacy of their recommendations. The recommendations are based upon a combination of their clinical experience in the  state of Illinois, knowledge of natural health literature, and vocational training obtained from licensed entities. A natural health consultation as provided by Karim Raimbekov, aka Ari Ra, aka Doctor Nature, does not constitute a medical service, or health care treatment, or a cure for any disease.

2. I also grant permission to Doctor Nature and Doctor Nature Healing to perform such examinations and therapeutic treatments as are considered necessary or advised for my diagnosis and Plan of Healing. I understand that I may look at my medical record at any time and may request a copy of it. There is a designated fee for processing of the documents, and it may take up to a week. I understand that the nature of the recommended healing regimen for my care, including but not limited to nutrition modifications, herbal supplementation, breathing techniques, exercise, yoga, and meditation, will be explained to me and that I will have the opportunity to ask questions of those involved in my care.I am not being forced to accept treatment or follow recommendations.   

3. The title of “Doctor” in “Doctor Nature” is used as a common noun to indicate the involvement of Ari Ra in the wellness and well-being of others and does not imply that he is licensed to practice medicine in the state of Illinois.

4. Individualized recommendations, are offered and applied as an educational and informative consultation. Any action taken as a result of the consultation is done at the sole discretion of the client. Therefore, it is strongly recommended that in addition to any health consultation that you maintain a relationship with one or more physicians qualified to care for health condition(s). For example, in the case of cancer, consult with an oncologist; in the case of cardiovascular conditions, consult with a cardiologist; in the case of children, see a pediatrician; in the case of child with autism, seek advice of a pediatrician and autism specialist; in the case of depression, see a psychiatrist, etc.

5. Your signature verifies that you have not been told to discontinue treatments with any other medical specialists or other health care providers. Your signature is being given prior to rendering any service, advice, and/or recommendations, whatsoever.

6. Financial Policy: Clients are fully responsible for all professional services, herbs, supplements, products or equipment received. We are not contracted with insurance companies and do not bill for services. I,the undersigned,understand that I am responsible for all charges. I understand that failure to pay is illegal.

   • We will collect full payment for any nutritional supplies, supports, and any therapeutic appliances the day they are recommended and you agree to the charges.

   • We will charge a $35 fee for any returned checks.

   • Consultation Cancellation:We require a 48-hour (business days) advance notice of an office or online visit cancellation.There is a 50% fee for visits not cancelled 48 hours (business days) in advance and for missing your appointment.

7. Supplements: Doctor Nature Healing and/or its sister company(ies) make available nutritional supplements and other health products. You are in no way obligated to purchase these products from this office or any other specific location or company. You may freely choose to purchase such products from any source(s) as you wish. Referrals: We may refer you to other natural healing practitioners. You are in no way obligated to take the advice and see this particular practitioner.

8. Follow up: It is the responsibility of the client to follow up with questions and to schedule follow-up visits. It should not be assumed on the part of the client that if they are not contacted by Doctor Nature Healing and its employees and/or sister company(ies), that health goals are met and no further healing regimen is necessary.Health recommendations and/or possible referral and additional follow-up may be warranted based upon the results of follow-up assessment and any new conditions

By typing or printing my name in the signature field below (which shall constitute my signature), I agree to comply with the above policies and acknowledge that I understand all terms, verbiage (language) and concepts herein. I understand this consent agreement and have executed it freely and willingly.