This practice has no direct dealing with the medical aid schemes. You are responsible for th payment.
Consultation and test payable on the same day.
I understand that the attending practitioners are not allopathic doctors (MOs) and do not portray themselves to be, but are providing biofeedback services. That the biofeedback procedures utilized include stress reduction protocols, relaxation techniques and pain management. I fully understand that the attending practitioners do not offer allopathic drugs, surgery, chemical stimulants or any other conventional treatments. In addition, they do not diagnose, treat or otherwise prescribe for my disease condiiton or illness, or perform any act thatwould constitute the practice of medicine for which a license is required.
I have solicited the attending practitioner's services in good faith, exercising my free will and following the dictates of my own conscience, which allows me to select what I understand, is most beneficial to my health. I am fully aware and releasethe practitioner to run biofeedback stress reduction protocols. Hereby I give my permission to the Alternative & Integrated Medical Practitioner to prick my finger for a sample of blood to perform a Microscopic Blood Analysis.
By signing below, I acknowledge that I have read and understand all parts of this waiver, that I had the opportunity to ask questions with regard to the described procedures and that I hereby affirm: I am not here for allopathic medical diagnostic or treatment procedures. I am here on this and any subsequent visits solely on my behalf. I presently seek biofeedback and other programs within the scope of the attending practitioner for stress reduction, relaxation, pain management and possible weight loss.