Consent for Consultation
_____ At the point of engaging consultative services from Ruckus Wellness, you be given this consent to sign. By voluntarily signing this form, you show that you have read or had read to you, this consent to treatment, have been told about the risks and benefits of nutritional and lifestyle consulting, and have had an opportunity to ask questions. You intend this consent form to cover the entire course of treatment for your present condition and for any future conditions for which you seek treatment.
_____ Ruckus Wellness is a clinical consultative service and currently limited to Minnesota Residents or clients that establish care with an in-person initial visit which occurs in Minnesota.
_____ Supplements and Neutraceuticals are likely to be recommended and as a service to you, Ruckus Wellness has provided links to companies that provide value with regards to their purity, quality, bioavailability, and effectiveness. You are under no obligation to purchase nutritional supplements through Ruckus Wellness.
_____ Ruckus Wellness is a consultation service and is not intended as a substitute for care provided by your personal physician. Ruckus Wellness strongly encourages you to share any and all laboratory results with your primary care provider to ensure you receive appropriate care.
_____ All matters regarding your health require medical supervision by healthcare professionals selected by you. You and your personal healthcare providers shall have exclusive authority and control over your health and healthcare, including all diagnosis, treatment and other determinations related thereto, and nothing discussed in a consultation between us, is intended to or shall influence, restrict or interfere with your personal healthcare professionals’ exercise of independent clinical, medical or professional judgment in providing healthcare services to you.
_____ As such, we shall not be liable or responsible for, and you hereby release us from, any loss or damage allegedly arising from any information or suggestions made during any consultation between us. The information in this medical disclaimer is stored electronically online and is neither governed by nor compliant with HIPPA regulations.