Informed Consent Form

Informed Consent

Naturopathic Medicine is the treatment and prevention of disease by natural means. Naturopathic Doctors assess the whole person, taking into consideration physical, mental and spiritual aspects of the individual. Gentle, non-invasive techniques are generally used in order to stimulate the body’s inherent healing capacity.

A number of different approaches may be used throughout the course of treatment. Naturopathic Doctors are trained in clinical nutrition, botanical medicine, homeopathy, Asian medical theory and acupuncture, hydrotherapy, lifestyle counseling, and physical medicine.

Even the gentlest therapies may cause complications under certain physiological conditions. For this reason, it is very important that you inform your Naturopathic Doctor of any and all disease processes you are suffering from, as well as any medications (prescription and over-the-counter) that you are taking. If you are pregnant, suspect you may be pregnant, or are breast-feeding, advise your Naturopathic Doctor immediately.

Health risks associated with Naturopathic Medicine include but are not limited to:

  • Aggravation of pre-existing symptoms during the healing process;
  • Allergic reactions to supplements or herbs;
  • Pain, bruising or injury from venipuncture or acupuncture.

Fee schedule (as of January 2018):

Patients are responsible for the total charges incurred (visit fees plus any medicines) for each visit. Services are not covered by OHIP but may be covered by your extended health care plan. If you have coverage for Naturopathic Medicine, you are responsible for billing your own insurance company. Most insurance companies will not cover the supplements we prescribe and dispense.

 

Fee Schedule1st Visit
(90 min)
2nd Visit
(60 min)
Follow-up
(45 min)
Follow-up
(30 min)
Adult$225.00$150.00$115.00$75.00
Child (Under 16)N/A$150.00
(1st Visit)
$115.00$75.00
Seniors (65 +)$210.00$140.00$105.00$70.00
Phone Visit$35.00 for each 10 minutes
Doula$1000.00 for Birth Doula Services
HypnoBirthing$300.00 per couple for 5 classes (each class is 2.5 hrs)

Any appointment cancelled with less than 24 hours notice will
be charged the full price of the missed appointment


I have read and understand the above-stated policies and information. I intend this consent form 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.


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51 George Street
Waterloo, ON
N2J 1K8

Phone: 519-575-6016
Fax: 226-444-6755

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