PLEASE READ BEFORE PRESSING SUBMIT
By Submitting this form, you consent for the Pure Joy Project to collect and store your personal information for the purpose of providing health care services. All information collected by the Pure Joy Project will be held in accordance with the Information Privacy Act 2009 and will not be disclosed to a third party without your written permission; or when disclosure is required by law.
You declare that the above information is true and correct and indemnify The Pure Joy Project and its practitioners of liability for any false or misleading statements provided. As a patient, you have the right to be informed about your health condition(s) and recommended treatment. This disclosure is to help you become better informed so that you may make the decision to give, or withhold my consent, for undergoing treatment.
You hereby request and consent to examination and treatment with Carly Meredith (Adv. Dip. Naturopathy) and/or other licensed / qualified practitioners of the Pure Joy Project. You understand that you have the right to ask questions and discuss your satisfaction with the treatment provided including suspected diagnosis or condition(s); the nature, purpose, goals, and potential benefits of the proposed care; the inherent risks, complications, potential hazards, or side effects of the treatment or procedure; the probability or likelihood of success; reasonable available alternatives to the proposed treatment procedure; potential consequences if treatment or advice is not followed an/or nothing is done.
All female patients must alert their provider if they have confirmed or suspect pregnancy, or are trying to conceive as some of the therapies may represent a risk to pregnancy including induced labour or early labour. Some treatments are not suitable during lactation or breastfeeding. You accept that your practitioner may not be able to anticipate and explain all the risks and complications and you wish to rely on the provider to exercise all judgement during the course of the procedure based on the known facts. You also understand it is your responsibility to request explanation of therapies and procedures to your satisfaction. You further acknowledge that no guarantee of services have been made to you concerning the results intended from any treatment provided. By submitting this form, you acknowledged that you have been provided with ample opportunity to read this form or that it has been read to you.
You have read and understand the above stated policies of the Pure Joy Project and will comply with them in all respects. You intend this as a consent form to cover the entire course of treatments for your present condition and any future conditions for which you seek treatment. You hereby authorise and consent to treatment.