Of my own free will, consent to be assessed and treated for my conditions by the therapist, Lisa Novick.
I understand that, for the purpose of integrated therapy, the following areas may be addressed during the course of a treatment: head, neck, shoulders, upper chest, arms, back, hips, abdomen, buttocks, legs, hands, feet, (breast tissue is excluded unless specifically indicated for clinical reason, in which case a seperate consent will be issued).
I understand that I can exclude any body part I choose to from the treatment session.
Alternative course of treatment (where applicable and relevant) have/will be explained to me, as well as the possible benefits, risks and side effects (if any), with regard to my therapist's proposed treatment plan upon meeting.
I understand if the therapist doesn't comply to the above, I can revoke my consent at anytime by informing the therapist, or simply asking for the information to be provided.
I feel that I fully understand what is involved in the proposed treatment (info provided on services page) and I trust my therapist will inform me of the possible consequences of not having the recommended treatments moving forward pertaining to my condition.
I acknowledge that I have fully disclosed all medical history, including what medications I am currently taking and if I have any allergies (i.e. Coconuts - coconut massage oil is used).
I understand I may change my mind regarding any aspects of my treatment at any time and upon informing my therapist of my decision, I may withdraw consent with the intent to alter or discontinue the treatment.
In compliance with the Health Information Act (section 34), I provide my full voluntary informed consent to treatment. I intend this consent to pertain to my entire course of treatment.