CONFIRMATION

  • CONSENT FORM

CONFIRMATION

This form applies to all forms of treatment(s) administered at Life Right Practice -­‐ all referred to under the general heading of 'treatment'

Prior to formal commencement of treatment I, the client, understand that

Treatment will require my active participation & commitment to achieve the best outcomes Treatment may at times be uncomfortable or present slight pain and I agree to discuss this with my practitioner
It will be beneficial for me to work on goals & objectives as recommended by my practitioner(s)
The importance of being honest & providing accurate feedback to help continue my treatment plan
Whilst the practitioners will always try & provide an indication of treatment plan duration, this cannot be definitive until all issues have been presented or identified
It may sometimes be necessary & beneficial to me that I am referred to more than one practitioner to best resolve my issue(s)
If my presenting issues have been apparent for longer than 3 months they may change or become worse for a short time
Sometimes the presenting issue is not the cause of what is happening to me, which may require that we look at other aspects.
It is my responsibility to disclose all relevant information & withholding anything whether intentionally or unintentionally can affect my treatment
Based on what I tell you concerning my presenting issues or via test results, nutritional supplements may be discussed to help with my overall wellbeing.
If I choose to include these, I agree to read the label and advise my GP and any other healthcare professional.
I accept full responsibility for any dosage and agree to discuss with my practitioner should I change this.
I agree to inform my practitioner & GP of any other nutritional supplements I take that have not been discussed with a Life Right Practitioner.
In some cases, to diagnose a condition, an examination where the practitioner needs to see my skin may be required. 
With my approval, my records may be passed to other practitioners to keep them involved and in knowledge of my progress.
Life Right may at times contact me via email, text or social media with details of services etc. (I can opt out at any time)
Life Right do not at any times disclose my details to any other person or organisation without my consent
Life Right may use any verbal or written feedback I provide for marketing purposes without disclosing my full name
My permission is given for Life Right to use any video feedback or testimonials provided for marketing purposes
I will be charged the full session fee if I fail to attend, or cancel an appointment within 24 hours.
I consent for any payment details previously provided to be used to cover this cancellation charge.
In the event of no payment details being available, I agree to clear the outstanding amount before further treatment commences.

Your name

Date of birth

CONFIRMATION

To confirm your acceptance, please type your name here