Informed Consent to Consultation & Waiver of Liability
[Sign and date at bottom]
Vedic Health Inc
401 E. Jefferson St, Suite 201, Rockville, MD 20850
1. The goal of all programs is to create within your body and mind an optimum environment for healing to take place and to maximize your body's ability to heal itself using the principles of Ayurveda.
2. The Vedic Health employee or independent contractor (“Ayurvedic consultant”) is not trained in Western medical diagnosis or treatments, is not a physician, nor a licensed health care professional, but rather a consultant using the principles of Ayurveda to guide the patient with a healthy diet and lifestyle.
3. No medical advice, diagnosis or treatment is given by the Ayurvedic consultant.
4. If you are suffering from a disease or symptom that has not been evaluated by a physician or other licensed health care professional, you must be evaluated by one. If you choose not to see such a provider, by signing this waiver you acknowledge that consultation with a physician has been recommended to you.
5. The Ayurvedic consultant will not alter in any way your prescriptions or other measures, protocols or regimens without written and express approval from your physician or other licensed primary health care provider.
6. Vedic Health Inc holds no liability for any products or supplements that may be suggested, that are not manufactured by Vedic Health Inc.
7. There is a suggested donation for our services. Your donations are tax-deductible. Vedic Health Inc is a registered nonprofit 501(c)3 organization. Retain your electronic receipt. Cancellations should be made 48 hours in advance.
I understand that this consultation and any assessment or information ensuing therefrom is for general educational purposes only and that no claim to medical diagnosis or treatment, or the cure of any medical condition, is inferred or implied. I further understand that this consultation and any recommendations ensuing therefrom should not be construed as a substitute for medical examination, diagnosis and treatment, and that I should see a physician or other licensed primary health care provider for any physical or mental ailment or complaint that I may have. I understand that an Ayurvedic consultation may include assessment of doshic conditions and related recommendations for dietary, herbal or other lifestyle regimens and that these are given from a traditional Ayurvedic perspective only. I understand that any suggestions or recommendations are in no fashion intended as a prescription for any condition. I understand that Ayurvedic consultants are not qualified or licensed to diagnose, prescribe for or treat any physical or mental illness, and that nothing said in the course of any consultation should be construed as such. I understand that any healing process requires my active participation and is my own