Get Declaration And Client Consent Form - Hawthorn Clinic

Filling out the Declaration And Client Consent Form is a crucial step in receiving treatments at the Hawthorn Clinic. This user-friendly guide will provide you with step-by-step instructions to complete the form online, ensuring a smooth and efficient process.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the Declaration And Client Consent Form and open it in your chosen editing tool.
2. Begin by entering your full name in the designated space at the top of the form. This identifies you as the client providing consent.
3. In section 1, indicate your consent for the treatments offered by Dr. Susan Ritcey by listing the specific treatments you wish to proceed with. Ensure that you understand each treatment before proceeding.
4. Proceed to section 2, where you will review and acknowledge that the treatments have been explained to you. You should check that you comprehend what will be done, the options available, and any potential risks or side effects involved.
5. In section 3, provide a detailed account of any prescription drugs, medications, or other treatments you are currently using. This information is essential for your safety during treatments.
6. Section 4 requires you to acknowledge your ability to seek further medical care from other professionals. Ensure you read this clause carefully and understand the optional nature of the treatments offered.
7. In section 5, recognize the licensing status of Dr. Susan Ritcey and the fact that services are not covered by provincial health insurance in Nova Scotia.
8. Review section 6, which addresses confidentiality. Confirm that you understand your information will be kept private unless legally required to disclose it.
9. In section 7, you will see details regarding your financial responsibilities for the treatments. Make sure you understand the policy concerning missed appointments.
10. Review section 8 to ensure that all statements in the form have been comprehended. Note your satisfaction with the answers to your questions.
11. Finally, in section 9, decide if you consent to receiving periodic emails about treatments and health information, and provide your signature along with your date of birth in the appropriate fields.

Complete your Declaration And Client Consent Form online today to ensure a seamless experience at the Hawthorn Clinic.