Dhanvantari Ayurveda Center Michael Dick, Ayurvedic Practitioner, Leesburg, Florida e-mail: firstname.lastname@example.org
DHANVANTARI AYURVEDA CENTER
aka: AYURVEDA EDUCATION PROGRAMS
CONTRACT / AGREEMENT
1) The Dhanvantari Ayurveda Center is a spiritually based organization (church), whose mission is ministering to the health needs of the public in the manner of Ayurveda, an ancient health care system believed to have originated in India.
2) I understand and agree that my evaluation and consultation with the Ayurveda Consultant and any recommendations for balancing physiology are not intended as or in replacement of my primary medical care and treatment. I will continue to seek the advice of my family doctor or any medical specialist with whom I have consulted, and I will not modify or suspend any treatment program recommended by others, as a result of the Ayurveda Consultant's suggestions.
3) I understand and agree that the Ayurveda Consultant is not conducting a medical examination for me.
4) If I am aware of or have been advised by any physician that I am suffering from any disease or disorder, I agree that I will disclose this information to the Ayurveda Consultant during my first consultation. (This will remain confidential.)
5) I understand and agree that the purpose of this consultation is strictly educational. It is conducted in the language of and about the model of Ayurveda as an unique perspective of cause and effect. Such information may include suggestions about diet, food supplements, lifestyle, emotions, spirituality, and more. The Ayurveda Consultant's recommendations, while intended as balancing and strengthening to the physiology, are not intended as treatments for specific medical disorders.
6) Because this service is educational, other kinds of health practitioners may be recommended to help you assess, diagnose, and treat according to legal constraints. It is believed that your health is best facilitated by a team-approach. Each provider assists you to find and to make the best choices. In this light, your interests are served best by complying with the recommendations you receive.
7) It is agreed that the period of this contract is limited to the duration of this consultation. There is no future performance stated or implied. Future or followup consultations may be arranged to discuss goals or needs arising at those times.
8) The Dhanvantari Ayurveda Center (church) operates on a donation basis.
Signed _________________________________________________ Date________________
© Copyright 1994 Michael Dick All Rights Reserved rev 1/11/06
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