NATURAL & CHINESE MEDICINE INFORMED CONSENT AGREEMENT
A Doctor of Natural Medicine (DNM) specializes in a distinct healing discipline that employs natural and non-invasive treatments. DNMs earn a minimum of 4,200 contact hours of education in subjects such as anatomy, physiology, organic chemistry, East/West medicine, herbology, counseling, dietary & lifestyle evaluations, nutrition, bodywork, stress management, and the like.
A DNM counsels the client/patient in the use of natural non-invasive complementary and alternative therapies and natural substances including food and nutraceuticals such as vitamins & minerals, herbal preparations, roots, barks, plant substances, and natural medicines of animal, mineral, or botanical origin.
My goal is to educate/inform you relative to therapies that may possibly assist you in obtaining and maintaining health naturally. Lifestyle modifications and many natural therapies are not intended to provide immediate effects, rather they are designed to bring about a gradual and gentle remediation over time.
A Doctor of Natural Medicine (DNM) is not the same as a Medical Doctor (MD), Doctor of Osteopathy (DO), or a Clinical Psychologist (PhD, PsyD, EdD), is not licensed in that way, and does not diagnose what they typically diagnose. Natural therapies, like any form of treatment, can have side effects/interact with treatments your primary care physician may have prescribed, so you are encouraged to consult with him or her.
You consent that, if you chose not to inform your primary care physician prior to or during complementary & alternative treatment, you are doing so of your own accord and release this provider from any liability in that respect. While there are a great number of research studies available on complementary and alternative treatments, including Chinese medicine, such therapies usually have not been tested according to FDA approved standards.
My specialization is Chinese medicine, however I do include Western natural healthcare as appropriate. Finally, any healthcare plan has a greater likelihood of success when the client / patient assists in the creation and implementation of that plan.
Confirmation Statement
I have read and understand the philosophy and training of a Doctor of Natural Medicine and the type of treatments offered by this provider. I am also aware of my freedom of choice in regard to therapies utilized in my natural healthcare plan.
Client/Patient_______________________________________
Date__________________________
Provider___________________________________________
Date__________________________
Brother / Doctor Bernard Seif, SMC, EdD, DNM, ABBHP
Clinical Psychologist / Board Certified in Behavioral Health Practice
Doctor of Natural Medicine / Chinese Medicine Specialist
