Naturopathic Nutrition
Case History Form

Client Copy

Terms of Engagement & Consent Form incl. case study consent between the CNM naturopathic nutrition student / practitioner & client.

Good nutrition supports the body’s natural defences and resistance. However, no claim can be made about the efficacy of any naturopathic nutritional advice.

The naturopathic nutrition student / practitioner:

  • Naturopathic nutritional advice will be tailored to support medically diagnosed conditions and / or health concerns agreed and identified by the two parties.

  • Naturopathic nutritional practitioners are not permitted to diagnose or claim to treat medical conditions.

  • Naturopathic nutritional therapy is not a substitute for professional medical advice and treatment.

The client:

  • You are responsible for contacting your GP or specialist about any health concerns you may have.

  • Please advise your GP of the naturopathic nutrition protocol you will be following. Please also advise any other complementary medicine practitioners you are consulting.

  • It is important that you tell your practitioner about any medical diagnosis you have received, any prescription medication, herbal medicine or food supplements or over-the-counter medication you are taking as it may affect the naturopathic nutritional programme.

  • If you are unclear about any part of your plan, then you should contact your practitioner immediately for clarification. Your student practitioner will then contact a qualified supervisor to seek advice before responding to you.

  • Your naturopathic nutritional programme and supplement plan will have a time frame and you should not continue with recommendations outside of this unless agreed by your naturopathic nutritional practitioner. This is to avoid any adverse reactions.

  • Please report any concerns about your programme to your naturopathic nutritional practitioner for discussion at your next consultation.

We / I understand the above and agree that our professional relationship will be based on the above content of this document. I consent to the use of a confidential video link to external students and supervisors for observational purposes only. I understand my case will not be videotaped. I further understand a student practitioner must have all suggestions authorised by a qualified supervisor. The supervisor may, therefore, enter the clinic room at any time. With these understandings, I consent to participate as a client in the student clinic. I understand that I am being seen for a nutrition consultation either by a student practitioner in his/her capacity as a final year naturopathic nutrition student, or a qualified supervising practitioner at the College of Naturopathic Medicine (CNM). I understand that my case may be written up as a case study but that my name and any personal identifiable details will be removed from the written submission. I understand that this consent form will be submitted to the College and that I may be contacted for verification.