All information on our website is for educational purposes only. Do not implement any new dietary or natural therapy information, without first checking with your healthcare provider.
If you are a client, you will be receiving more specific, individualised advice, including in our course material. Please check with your healthcare provider before implementing advice in our online courses. Functional Medicine is a holistic approach to wellness and disease. Our practitioners assess each individual as a whole, considering physical, emotional and spiritual aspects, which may be affecting overall health and well being.
Different approaches may be used during course of treatment. These modalities are, but not limited to, nutritional supplements, mindset coaching, Neuro-Linguistic Programming, manual therapy, individualised diets and lifestyle counselling. There are, however, risks associated with any treatment, and we are required to inform you of these.
Even the gentlest therapies may cause complications in certain physiological conditions. This depends greatly on the individual and the extent of the illness. Some therapies must be used with caution in certain diseases such as diabetes, heart, liver or kidney disease.
It is very important, therefore, that you inform your practitioner immediately of any disease that you are suffering from as well as any medications (prescription or over-the-counter) that you are taking. If you are pregnant, suspect you are pregnant, or you are breast-feeding, advise your practitioner immediately.
Statement of Acknowledgement
In order to clarify our position as health care practitioners, and our mutual responsibilities in your health care, we ask for your cooperation in signing this statement of acknowledgement.
1. That you understand that Clinical Nutritionists / Functional Medicine Practitioners / NLP practitioners are not Medical Doctors; that we use non-invasive, natural methods of assessment and treatment of body dysfunctions. You understand that any significant symptoms should be reported to my doctor. It is also recommended that you discuss the use of any nutritional supplements with your doctor before implementing. We do not service medical emergencies. If you have a medical emergency, you must contact your primary care physician or call 000.
2. That you understand that treatment and/or referral to other health practitioners is based upon the assessment of your health revealed through personal history, physical examination, laboratory testing and other appropriate methods of evaluation.
3. That you understand that the ultimate responsibility for your health care is your own, and that we are here to support you in this.
4. You understand that a record will be kept of health services provided to yourself. This record will be kept confidential and will not be released to others outside of our clinic unless you give your consent or the law requires it. Some of the information (including health information) collected by us may be disclosed to employees or contractors of Chris & Filly Functional Medicine outside of Australia. You consent to your information being disclosed to a destination outside Australia for this purpose, including but not limited to Cebu, Philippines, and you understand and acknowledge that Australian Privacy Principle 8.1 will not apply to such disclosures of your personal information.
5. At times, with your consent, we may show laboratory test results to our functional medicine mentors, to assist in analysis and best care. Your personal details will always be removed from results, to protect your identity.
6. You understand that your practitioners will answer any questions to the best of their ability. You understand that results are not guaranteed. You do not expect your practitioner to be able to anticipate all risks and complications, such as allergic reactions to supplements. You will rely on your practitioner to exercise judgment during the course of the procedure, which they feel at that time is in your best interests based on the facts then known.
7. You understand and agree that all services rendered to yourself are charged directly to you and that you are responsible for payment. You also understand that if you suspend or terminate your care and treatment, any fees for professional services rendered to yourself will be immediately due and payable. You authorise us to release your personal medical information to yourself.
10. You understand that if you are unable to keep your scheduled appointment, you must notify the office a minimum of 48 hours before your scheduled time or you will be charged a cancellation fee of $50.
11. You understand that lab testing cannot be refunded. Return of supplements require pre-approval. Refrigerated items cannot be returned. No non-refrigerated supplement returns will be accepted after 30 days on all regularly stocked items. Special orders cannot be returned.
You understand this consent form is to cover the entire course of your treatments.
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14. This agreement shall be governed by and construed in accordance with the laws of the State of California, without giving effect to any principles of conflicts of law. You further submit to the exclusive jurisdiction of the state and federal courts sitting in Orange County, California. If any provision of this agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.
Last Updated: 13 July, 2021