Waiver, Indemnity & Informed consent (required)

This waiver and indemnification agreement applies to the wellness program(s) and services provided to guests and employees of ADRA Canada by Paradise Health Clinic

WAIVER

The undersigned patient agrees to waive any claim for damages of any nature whatsoever and to release Paradise Health Clinic, and  ADRA Canada, and each of their respective subsidiaries, affiliates, officers, directors, employees, volunteers and agents from any liability or responsibility whatsoever for any ill-effect, injury, or loss incurred by the guest or any third party including, but not limited to, all manner of actions, causes of action, suits, debts, damages, claims, demands, costs, losses and expenses of any type or kind whatsoever, arising from, connected with or related to the consumption of food, and the availing of services.

INDEMNIFICATION

Patient agrees to indemnify, defend and hold harmless Paradise Health Clinic, and  ADRA Canada, and each of their subsidiaries, affiliates, officers, directors, employees, volunteers and agents from and against all liability, claims, actions, causes of action, suits, demands, damages, judgments, costs, losses and expenses, including reasonable attorney’s fees, to which any of the above-named parties may be subject, including, but not limited to, any claim for any injury to or the sickness or death of any person or persons, or for damages to property or otherwise, arising from, connected with or related to the to the consumption of food, and the availing of services.

INFORMED CONSENT

Paradise Health Clinic utilizes the principles of Naturopathic, Nutrition, Massage Therapy and Lifestyle Medicine to assist the body’s own ability to heal and thrive.

The components of your session will include:

• Body composition analysis
• Vitals (blood pressure, waist circumference, height, pulse, temperature)
• Physical exams (example auscultation of the heart to assess cardiovascular conditions)
• VO2 max (progressive treadmill test to maximal exertion to assess cardiorespiratory fitness)
• Musculoskeletal fitness assessment (grip strength, push ups, sit and reach, vertical jump, back fitness and balance assessments
• Blood test prior to arrival
• Consults with the following clinicians: medical doctor, naturopathic doctor and exercise physiologist

During your session, the clinicians will review your health history, results from the various assessments and use these to make recommendations regarding relevant lifestyle changes, natural therapies, supplements, medications, referral to external services and other necessary suggestions.

A number of different approaches may be recommended during your session:

• Clinical nutrition and nutritional supplements
• Nutritional counselling
• Botanical/Herbal Medicine
• Physical Medicine
• Lifestyle medicine (including but not limited to sleep, exercise, stress management, and spirituality)
• Exercise medicine
• Pharmaceuticals
• Hydrotherapy

The slight health risks of some modalities include, but are not limited to: aggravation of pre-existing symptoms or conditions, allergic reaction to supplements or herbs and pain.

Although naturopathic medicine, lifestyle medicine, nutritional therapies, massage therapy, psychotherapy and hydrotherapy are very gentle therapies, even these may induce complications in certain physiological conditions such as pregnancy, lactation, very young children, very elderly and in certain conditions including but not limited to diabetes, liver, heart or kidney disease. It is therefore important to inform your clinicians of any illnesses you suffer from or medications you may be taking (prescription or over-the- counter). If you are a female and are pregnant, suspect you may be pregnant or are nursing, please advise your clinician immediately.

TELEMEDICINE SERVICES

There may be certain instances where both patient and the clinician may deem it most appropriate to do consults by telephone or using conferencing software. Telemedicine is the use of electronic information and communication technologies by a healthcare provider to deliver services to a patient when he/she is located at a different site than the provider.

I understand that the laws that protect privacy and confidentiality of medical information also apply to telemedicine. As always, your insurance carrier will have access to your medical records for quality review/audit.

I also understand that during a telemedicine consult: - there are limitations to the level of physical examination that the clinician can perform. - I may revoke my consent orally or in writing at any time by contacting the clinic via phone (289-763-5888), text (289-763-5994) or email info@paradisehealth.ca

CONSENT

As a patient of Paradise Health Clinic:

• I am at liberty to seek or continue medical care from a medical doctor or other health care provider.
• This consent form is intended to cover the entire course of treatment for my present condition.
• I understand that I am free to withdraw my consent and to discontinue participation in these procedures at any time.
• I understand that a record will be kept of the health services provided to me. This record will be kept confidential and will not be released to others without my consent, unless required by law.
• I understand that I may look at my medical record at any time and may request a copy of it by paying the appropriate fee.
• I understand that the clinician will answer any questions I have to the best of his ability.
• I understand that the results are not guaranteed.

With this knowledge I voluntarily agree to the diagnostic and therapeutic treatments above. I understand that treatment advice will not be given over the phone or via e-mail unless directly relating to specifics discussed during a clinic visit.

I accept full responsibility for any fees incurred during care and treatment. I understand that charges are to be paid at the time of the visit unless previous arrangements have been made prior to my scheduled appointment.