Informed Consent Agreement Points.
Applicants must reply "Yes" to thses points on the Health History Questionnaire to be eligible for a "Wellness Discussion" with Dr. Lonsdorf |
| 1. I understand and agree that I am involved in an Ayurvedic educational program and NOT a medical consultation and that by participation, I will not become Dr. Lonsdorf's patient. I understand the knowledge I receive is educational information and is NOT a substitute for modern medical evaluation and treatment or for preventive testing (such as blood tests, Pap smears, mammograms, and any other appropriate screening tests.) |
2. I understand that Maharishi Ayurveda uses a unique system of evaluation and treatment based on the concepts of balance, doshas and overall tissue health. I understand that the educational information provided me is based on the Maharishi Ayurveda health approach to help enliven the inner intelligence of the body and restore balance to the divisions of inner intelligence. |
3. I understand that the educational information I will receive is NOT for the purpose of diagnosing or treating any disease that I may have. For the treatment of any diagnosed disease that I may have, I agree to continue under the care of my family doctor and continue to seek the advice of any specialists with whom I have consulted. |
4. I agree not to modify or suspend any medical treatment program that I am now receiving, based on the information I receive. |
5. I understand that it is very important that I provide information that is as accurate and complete as possible. If I am aware of or have been advised by any physician that I am suffering from any disease or disorder, I agree that I will disclose this information to the physician in writing in this questionnaire. I also agree to disclose any medication or treatments that I am currently receiving. |
6. I understand that it is not within the scope of this Educational Program for Dr.Nancy Lonsdorf to assume responsibility for the treatment of specific health problems. I represent that no claims have been made to me that this program is for the treatment of health problems or for the diagnosis, treatments or cure of any particular health problem. I understand that what I will be receiving will be educational information as to the Maharishi Ayurveda approach to enlivening and balancing the inner intelligence of the body. |
7. I understand that the Maharishi Ayurveda programs have been developed in part by Ayurvedic scholars associated with universities or other institutions. However, I recognize and agree that any advice or recommendations to me are the sole responsibility of Dr. Nancy Lonsdorf and no other person or organization. |
8. I understand that any herbal food supplements recommended for me are not drugs and do not treat any disease. Any other programs recommended also do not treat any disease, but are alternative approaches which are for the purpose of specifically balancing the doshas, or underlying intelligece of the physiology, for the purpose for creating balance in the physiology and improving overall mental and physical well-being. |
9. I understand that any herbal food supplements and other treatments and recommendations that I may be recommended have not been evaluated by the Food and Drug Administration nor are these approved by the FDA for the prevention, diagnosis, treatment or cure of any disease condition. |
10. I understand that while the recommendations of the Maharishi Ayurveda program are usually free of harmful side-effects, I am aware that individuals can react differently to diet, spices, herbs and lifestyle changes. I understand that I am advised to consult my personal physician before implementing them or changing my diet. If I use them I am electing to adopt these suggestions at my own risk. I further understand that such suggestions and treatments are not medically necessary for my condition, and that the physician's liability insurance may not cover adverse outcomes that may occur with these treatments |
11. I recognize that no claims or guarantees have been made to me regarding specific medical benefits or improvement in my medical condition(s) that I will receive as a result of any educational information I may receive. |