I have been advised that nutritional and wellness treatments and therapies, like all forms of health care, hold certain risks. Treatment objectives as well as the risks associated with light therapy, and nutritional therapy and, all other procedures, provided at Radiant Results have been explained to me to my satisfaction and I have conveyed my understanding to the case manager. After careful consideration, I do hereby consent to treatment by any means, method, and or techniques, to treat my condition at any time throughout the entire clinical course of my care.
Notice of Privacy Practices Acknowledgement
I understand that I have certain rights of privacy regarding my protected health information, under the Health Insurance Portability & Accountability Act of 1996. (HIPAA). I understand that this information can and will be used to:
1. Conduct, plan and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
2. Obtain payment from third-party payers.
3. Conduct normal healthcare operations, such as quality assessments and physicians certifications.
Indemnification & Non-Medical Disclaimer Clause
I understand and acknowledge that Radiant Results is not a medical office and does not provide medical diagnosis, treatment, or physician-supervised care. Any references within program materials to “doctor supervised,” “physician-supervised,” or similar terminology are general educational descriptions of weight-loss principles and do not imply that my individual program is overseen by a medical doctor. I agree that all recommendations provided by Radiant Results—including nutrition guidance, lifestyle suggestions, red light therapy, and wellness protocols—are non-medical, elective services intended to support overall well-being. I further acknowledge that I am responsible for consulting my own physician regarding any medical conditions, medications, or health concerns. In consideration of participating in these services, I agree to indemnify, defend, and hold harmless Radiant Results, its owners, employees, and contractors from any and all claims, liabilities, damages, or expenses arising from my participation, except where prohibited by law.
I acknowledge that I may request your NOTICE OF PRIVACY PRACTICES containing a more complete description of the uses and disclosures of my health information. I also understand that I may request, in writing, that you restrict how my private information is used or disclosed to carry out treatment, payment, or healthcare operation. I also understand that you are not required to agree to my requested restrictions, but if you do agree, then you are bound to abide by such restrictions.