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Patient consent form

General Explanation

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  • This test uses innovative non-invasive technology for diagnosis and treatment of diseases.
     

  • During the test, the practitioner will pass a weak electrical current of 1.2 volts that is not felt between the hands. The test is not painful and does not cause any harm. To the test, you must come with a cotton shirt without jewelry, perfumes, and bring with you samples of all the medicines you take, dietary supplements, medicinal plants, tinctures, cannabis flowers, Bach flowers, and homeopathic remedies.
     

  • Treatment is performed using small sugar pills and a tiny amount of alcohol approved for food without the addition of any chemical substance. note. Small amounts of sugar do not significantly increase blood sugar levels.

 

  • The clinic's team of practitioners, who have undergone professional training and are committed to investing their time and making every effort to bring the patient to recovery from their illness. All treatments are carried out under professional supervision and control. However, despite the high efficacy of the treatment, it is not possible to guarantee healing or therapeutic success in advance.
     

  • For the success of the treatment, it is your responsibility to arrive on time for diagnosis, to receive treatment, and to follow the treatment guidelines as prescribed by the treating team.

 

  • The duration of treatment and the number of required appointments will be determined according to the depth of the medical problem and the pace of progress in treatment.
     

  • Treatment is not intended for the treatment of cancer, heart disease, or irreversible bodily damage and is prohibited for people with pacemakers or patients suffering from life-threatening heart rhythm disorders.
     

  • Treatment does not replace conventional medical treatment, and any decision regarding therapeutic change should be consulted with the treating physician.
     

  • In any case where there is concern for life or permanent physical damage, treatment should not be relied upon as the sole treatment, and referral to conventional treatment as accepted in the Western world should be sought.
     

  • The test results cannot be relied upon as a conventional laboratory test as there has not yet been a correlation between the tests.
     

  • The treatment is specific to the patient and cannot be transferred to another person. Any treatment given to a person who has not undergone diagnosis is at their own discretion and responsibility.

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Patient Declaration and Consent:

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  1. I declare and confirm that I have expressed my request and expectations for treatment and that I have received a detailed explanation of the treatment process, its consequences, and side effects, including: the nature and method of treatment, the expected results, the professional aspects, and the limitations that are an integral part of managing expectations.
     

  2. I hereby confirm that I will not make any claims or allegations against the clinic or the healthcare professionals if the treatment goal is not achieved or in the event of treatment cessation and/or cancellation.
     

  3. I undertake that I will not seek any reimbursement and/or make any claim to my health insurance fund in connection with the treatment.
     

  4. I hereby declare that I do not have any implanted cardiac devices, such as a pacemaker, nor do I suffer from any cardiac arrhythmias.
     

  5. I hereby consent to the opening of a medical record for the purpose of monitoring the treatment, recording personal data, treatment data, reactions, and outcomes, and personal information (age, gender, and medical history, if any).
     

  6. I hereby agree to the use of treatment data according to the records in the medical record, including publication of the results before and after, their presentation, and use in medical presentations, lectures, medical publications, and various media, subject to maintaining the confidentiality and personal privacy according to the accepted ethical principles in medicine.

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I hereby declare that I have read and understood the contents of this letter, and I fully consent to the examination and treatment. I confirm that all the information I have provided is correct, and my signature on this letter constitutes consent to all of the above.

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Download 'Patient consent form'
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