I ______________________ I hereby consent to and authorize Corinne Angelica Wellness to provide professional healthcare services on my behalf.
My treatments are intended to rebalance your hormonal system, improve your energy, alleviate pain, and restore your body, psyche, and spirit for long-term healing resolutions. I am happy to work directly with other physicians and therapists that you currently work with so long as their treatments do not interfere with my treatments and are in your best interest. I am here to help YOU achieve the results you want and DESERVE!
As a new Client, I agree to:
- Fully disclose all physical and/or psychological health conditions that may be necessary for my Holistic Nutritionist to know in order to assure my safety, honor my emotional history, and allow my Nutritionist to provide me with the best possible healing experience.
- Inform my Nutritionist immediately, via Voxer or email, of any physical or emotional discomfort or pain following a consultation.
I hereby authorize my Nutritionist to recommend the following types of protocols as necessary to facilitate my healing and design recommended treatments:
Holistic use of nutrition: Therapeutic nutrition and nutritional supplementation.
Botanical (herbal) medicine: Botanicals may be prescribed as teas, tinctures, capsules, tablets, or creams.
Lifestyle counseling and hygiene: Promotion of wellness including recommendations for movement, sleep, stress reduction, mindset and habit shifts.
I recognize the potential risks and benefits of these procedures as described below:
Potential risks: allergic reactions to prescribed herbs and supplements, side effects of natural medications, aggravation of pre-existing symptoms, discomfort, nausea, lightheadedness, inconvenience of lifestyle changes. Please notify me if you experience ANY symptoms which may be secondary to the above procedures or if ever in doubt! As always, please consult your medical care provider before starting a new supplement regimen.
Potential benefits: restoration/balance of hormonal health, PCOS management, boosting fertility, restoration of energy, health & the body’s MAXIMAL functional capacity WITHOUT the use of pharmaceuticals or surgery, relief of pain & symptoms of disease, and prevention of disease or its progression.
Notice to pregnant women: All female clients must alert me if they know or suspect that they are pregnant as some of the therapies used could present a risk to the pregnancy.
With this knowledge, I voluntarily consent to the above procedures, realizing that no guarantees have been given to me, by Corinne Angelica Wellness, regarding cure or improvement of my condition. I understand that I am free to withdraw my consent and to discontinue participation in these procedures at any time.
I understand that a record will be kept of the health services provided to me. This record will be kept confidential and will not be released to others unless so directed by myself, my legal representative, or unless it is required by law. I understand that information from my medical record may be analyzed for research purposes and that my identity will be protected and kept confidential. I understand that any questions I have will be answered by my Holistic Nutritionist to the best of her ability.
All information & rights are reserved to Corinne Angelica Wellness. I understand that if I, the client, share this course with someone else, I will lose access without refund.
Acknowledgment and Waiver
- I have read all the foregoing information and I understand that the ultimate responsibility for my health is my own.
- I will be seeing a Certified Holistic Nutritionist and not a Medical Doctor.
- Any treatment or advice given to me as a client of this practice is not mutually exclusive from any treatment or advice that I may receive now, or in the future, from another licensed healthcare provider.
- I am at liberty to seek or continue medical care from a physician or surgeon or other healthcare provider.
- No employee, agent, or anyone else under this clinic’s direction or control is suggesting or recommending to me to refrain from seeking or following the advice of another health care provider.
- The programs rendered or recommended by this practice may be different than those usually offered by a medical doctor or other licensed health care provider.
- I have read, understood, and agreed to all information, rules, and disclaimers contained in my documents.
- I understand that my payment is NON-REFUNDABLE.
- I agree to pay the rate listed above in full or previously agreed upon payment plan/early bird pricing.
- I recognize that I can contact Corinne via Instagram or the Facebook group.
I HEREBY CONSENT TO PARTICIPATE IN
FLOURISH IN YOUR FIRST TRIMESTER ACCORDINGLY.