PATIENT CONSENT FORM
This consent form is designed to provide you with clear information about the supportive cancer care management you will receive as part of our program. Please read the following statements carefully and ensure you understand them before signing. If you have any questions or concerns, feel free to discuss them with your healthcare provider.
Nature of Care
This care is supportive in nature and is not intended to replace your conventional cancer treatment. It serves as an adjunct to help manage symptoms and challenges associated with your disease and/or ongoing care.
Scope of Care
The therapies, medicines, and supplements provided are designed to complement, not substitute, your mainstream cancer treatment. You are encouraged to continue consulting with your primary oncologist or treating physician regarding your core care plan.
Safety and Monitoring
Generally, the medicines and supplements used in this program are considered safe and are not expected to interfere with your mainstream cancer treatment. However, should you experience any discomfort, side effects, or symptoms you believe may be related to these care approaches, you must immediately discontinue use and inform your healthcare provider.
Voluntary Participation
Participation in this program is entirely voluntary. You have the right to withdraw from this supportive care at any time without prejudice to your conventional treatment or other medical services.
Acknowledgment of Risks and Limitations
While every effort is made to ensure the safety and efficacy of the supportive care, there may be risks or limitations that are unforeseen. By signing this form, you acknowledge that no guarantees are being made regarding the outcomes of this supportive care.
Disclosure of Information
It is your responsibility to provide accurate and complete information about your medical history, current treatment, and any allergies or sensitivities. Failure to disclose such information may increase the risk of adverse effects.
Coordination of Care
This program encourages open communication and coordination with your primary oncology team. Please provide us with relevant medical records or updates to ensure care approaches align with your overall treatment plan.
Informed Consent
By signing this form, you confirm that you have been fully informed about the nature, scope, and potential risks of the supportive cancer care. You understand the purpose of the care and agree to proceed.
Legal Disclaimer
The care offered in this program is complementary and does not constitute medical advice, diagnosis, or a substitute for professional oncology treatment. The program is not liable for any consequences arising from undisclosed medical conditions or deviations from the prescribed conventional treatment.
Contact Information
Should you have any concerns or need assistance, please contact your healthcare provider immediately.
