Terms & Conditions

Statement of Acknowledgement and Informed consent to Examination and compilation of protocol.

This form must be signed before our consultation can commence.

Welcome to LARA PEPPER. Pilates. Nutrition. Massage. This clinic utilizes the principles and practices of Pilates, Naturopathic Medicine and Sports Massage to assist the body’s own ability to heal and to improve the quality of life and health through natural means. Naturopathic nutrition assesses the whole person, assessing mental, emotional and physical health. During your visit, a thorough health history will be taken and if needed measurements such as weight, hip to waist measurements (no clothes need to be removed), and blood pressure, may be taken.

By signing this statement of acknowledgment, you understand that:

1. I am a Naturopathic nutritionist and NOT a conventional medical doctor (GP). Any treatment you receive is not mutually exclusive from any treatment or advice you may now be receiving or may received in the future from any other licensed health care practitioner.
2. The methods I may use have a proven clinical foundation, yet may not be recognised or accepted by standard (allopathic) medicine.
3. The treatment and/or referral to other health care practitioners is based on the assessment of your health, revealed through personal history, examination, laboratory testing, and any other appropriate method of evaluation.
4. I reserve the right to determine which cases fall outside my scope of practice, in which event the appropriate referral will be recommended.
5. You are not an agent of any private or government agency attempting to gather information without so stating your intentions.
6. Changes in dietary habits are not an absolute prerequisite for treatment and you understand that failure to follow sound nutritional, exercise and lifestyle programs could undermine any expected results.
7. You are accepting or rejecting this care of your own free will.
8. The ultimate responsibility for your health care is your own and that I am here to support you in this. I reserve the right to discontinue my services where it is apparent that your expectations and what I can provide are not in agreement.
9. Understanding that all fees, for services and supplements are payable prior to the appointment by the client or the guardian. Notice of 24 hours is required for appointment cancellations, otherwise you will be charged for the session in full.
10. I also recognise that even the gentlest therapies, supplements and medications potentially have their complications in certain physiological conditions, in very young children, in those on multiple medications, in pregnancy, while breastfeeding and hence the information provided is complete and inclusive of all health concerns including risk of pregnancy; all medications, including over the counter drugs and supplements. The slight health risk of some Naturopathic treatments include, but not limited to; aggravation of pre-existing symptoms, allergic reaction to supplements.

 

NAME:

SIGNATURE:

DATE: