Health Coach Consent
I understand that Dr. Stacey Shillington ND is not licensed to practice naturopathic medicine outside Ontario, Canada and cannot dispense medical advice nor prescribe treatment. Rather, she provides education to enhance my knowledge of health as it relates to food, dietary supplements and behaviours associated with skin care and eating. While this nutritional and botanical support can be an important part of my health care I understand it is not a substitute for the diagnosis, treatment or care of disease by a medical provider. I understand that I should discuss any dietary changes or potential dietary supplement use with my medical doctor and I should not discontinue any prescription medicines without first consulting my doctor.
I understand that I take full responsibility for my health and well-being and decisions made during Naturopathic Beauty's 7-Week Clear Skin Program, lead by Dr. Stacey Shillington ND.
In consideration of my participation in the above services, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release Dr. Stacey Shillington, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation, whether caused by negligence or otherwise.
I understand that any therapies I undertake as a result of the 7-Week Clear Skin Program are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Dr. Stacey Shillington is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.
I HAVE CAREFULLY READ THIS AGREEMENT AND BY PURCHASING THIS PROGRAM IT IS A FULL AND FINAL RELEASE OF ALL COSTS, CLAIMS, CAUSES OF ACTION AND DAMAGES OF ANY KIND ARISING FROM OR IN CONNECTION WITH DR. STACEY SHILLINGTON AND NATUROPATHIC BEAUTY.
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