Client Consent and Waiver Form
Consent for Care and Cancellation Policy:
By booking an appointment and participating in the Naturopathic programs offered by Urban Alchemy, you acknowledge and consent to the following terms and conditions:
Purpose of Care: I hereby give consent for care at Urban Alchemy Clinic to receive advice and education on my health goals within the context of the Naturopathic & Herbal medicine philosophy.
Responsibility for Well-being: I understand and agree that the treatment recommended will be based on the information I provide regarding my overall health and that I am fully responsible for my well-being before, during, and after the Naturopathic session, including my choices and decisions.
Client Confidentiality: I accept that if my Naturopath suspects that I or someone I know is at risk of harm, they reserve the right to contact the relevant authorities, and the client confidentiality clause will be null and void.
Non-Medical Advice: I understand and acknowledge that the services offered by Urban Alchemy do not constitute medical advice. The information provided is not intended to replace the advice of a licensed medical professional.
Educational Purposes: I understand and agree that any information provided during a session or via email is strictly for educational purposes. It does not involve the diagnosing, treatment, or prescribing of remedies for the treatment of disease.
Treatment Guidelines: I have the right to make decisions regarding the treatment that is best for me and will aim to follow treatment guidelines and recommendations set forth by myself and the Naturopath following our appointment.
Cost of Products: I understand that the cost of herbal formulas and supplements is not included in the consultation fee.
Cancellation Policy: I will provide as much notice as possible if I need to reschedule my appointment, acknowledging that there may be others waiting for appointments. Cancellation with less than 36 hours’ notice will incur a processing fee of 20% of the appointment fee. Cancellation with less than 24 hours’ notice or failure to attend a scheduled appointment will result in a 100% cancellation fee.
Late Arrival: Arriving late to your appointment may result in a shortened consultation time to accommodate other scheduled appointments. No refunds or discounts will be provided for shortened appointments due to late arrival.
Changes to Terms and Conditions: Urban Alchemy reserves the right to update or modify these terms and conditions at any time without prior notice. It is your responsibility to review these terms periodically for any changes.
Waiver and Liability Release
By participating in the Naturopathic programs offered by Urban Alchemy, I, the undersigned client, agree to the following terms and conditions:
Awareness and Assumption of Risks: I acknowledge and understand that participation in the program carries inherent risks, including but not limited to physical injuries, allergic reactions, sickness or death, and mental harm in connection with the Naturopathic recommendations. I accept full responsibility for my safety and well-being. I understand the scope, nature and extent of all the risks associated with participation in the Naturopathic program, and I freely and voluntarily accept and assume all such risks, dangers and hazards, including the risk of serious physical injuries or death. I take full responsibility for my actions, safety and welfare, and accept that Urban Alchemy has no liability in tort or contract or otherwise to myself and/or anyone associated with me for any adverse consequences associated with participation in the program, including any physical or mental harm or injury, or death.
No Medical Conditions: I certify that I do not have any medical conditions that would prevent me from participating in the program activities, including but not limited to the use of herbal medicine and supplementation. I understand that it is my responsibility to abstain from participating if there is a known medical condition that would cause injury or harm as a result of the program activities.
Drugs and Alcohol: I agree that consuming alcohol, medication, or drugs during the program may compromise my ability to safely participate. I accept full responsibility for any consequences resulting from such consumption. I understand that the combination of alcohol, medications, and drugs can cause unexpected side effects that can severely affect my health and ability to complete the program.
Release: I hereby release, remiss, and discharge Urban Alchemy and its representatives from any present or future claims, plan of action or demands of any kind, including those related to negligence or failure to protect.
Indemnification: I agree to indemnify and hold harmless Urban Alchemy and its representatives from any claims brought against them by any person.
Promise Not to Sue: I covenant not to initiate or assist in the prosecution of any claims arising from my participation in the programme.
No Partnership: I acknowledge that no partnership relationship is implied by this agreement.
Governing Law: This agreement shall be governed by the laws of New Zealand, and any disputes shall be resolved in the courts of New Zealand.
Severability: I acknowledge that this waiver is reasonable, valid and enforceable. If any provision of this agreement is found to be invalid or unenforceable by the court, the remaining provisions shall remain in full force and effect.
Legal Advice: I have had sufficient time and opportunity to consult with independent legal counsel regarding this waiver, and if I have opted not to obtain legal advice before executing this waiver, I cannot use this as a defence or otherwise.
By clicking the “I have read and agreed to the terms above” button in the booking form, I confirm that I have read and fully understand the provisions of this waiver and liability release. I further confirm that I have executed this agreement voluntarily and without duress.