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MEDICAL CONSULTATION 

CONSULTATION FORM

1. Consultation Purpose The information and recommendations provided during this consultation are intended solely for general wellness and informational purposes. They should not be considered a substitute for professional medical diagnosis, treatment, or advice from a licensed healthcare provider.


2. Accuracy of Information To the best of my knowledge, the information I have provided to the clinic is accurate and complete. I understand that any omissions or inaccuracies may affect the recommendations provided during the consultation.


3. Patient Responsibility Any decisions regarding your health and wellness, including changes to your treatment, medication, lifestyle, or diet, should be discussed and agreed upon with your primary healthcare provider. You are responsible for consulting with a qualified healthcare professional before undertaking any new health practices or treatments suggested in this consultation.


4. Limits of Liability Our clinic and its healthcare professionals assume no responsibility for any harm, injury, or adverse outcomes resulting from actions taken based on the consultation provided, particularly if such actions are taken without consultation with your primary healthcare provider.


5. Privacy and Confidentiality Your privacy is of utmost importance to us. Any information shared during this consultation will be kept confidential in accordance with applicable privacy laws and will only be used for purposes related to your care.


6. No Guarantees We strive to provide personalised recommendations based on the information you provide; however, we cannot guarantee specific health outcomes as results may vary.

Personal Data

Birthday
Day
Month
Year
Gender
Multi-line address
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By Clicking submit you are confirming that the information provided is to the best of your knowledge true and accurate. Any information that is not disclosed may affect the decision the clinician makes, and may affect your health. In the instance of withheld information the clinician is not responsible for any adverse effects of treatment

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