Consent form

Please fill in this consent form either online (below) or download this Word version to email back to Jane.

Consent

I understand that Jane Fowler does not claim to cure any illness or disease physical or mental health issues with any Alternative Therapies.

• I take full responsibility for my health and wellbeing and accept the outcomes of any advice or therapy I receive in this clinic as being complementary and not in place of professional medical treatments. I understand the therapies and procedures do not diagnose disease.
• I understand that if my practitioner is offering emotional coaching techniques and that these are not in place of counselling, psychotherapy or psychiatry and I will continue with any treatments or medications given to me by other mental health professionals. If this work triggers any pre-existing mental health issues, I will consult my mental health professional.
• I understand I will inform Jane Fowler in full of any existing medical or mental health conditions.
• I am to continue all medications and other treatments given by doctors as they are prescribed unless otherwise directed by the doctor who prescribed them.
• I am to disclose any previous anaphylaxis (sensitivity reaction) before treatments can commence so that every care can be taken to avoid direct contact with allergens and treatments.
• My clinic notes and data will be stored securely and will be retained for 5 years then be disposed of securely. I have the right to see my notes at any time.