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.