Assumption of Risk and Release of Liability
I hereby acknowledge and agree:
1.The purpose of nutritional counselling is to improve the overall health, vitality, and well-being of the body through nutritional education and the use of natural foods and non-medicinal nutritional supplements. The Registered Dietitian, Robin Reynolds, does not diagnose diseases, disorders, or conditions.
2. The Registered Dietitian, Robin Reynolds, is not a licensed Naturopathic Doctor or Medical Physician.
3. As part of the Nutritional Counselling Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle, and diet. This information is collected to enable the Registered Dietitian to: (i) assess my knowledge of nutrition, (ii)
education me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality, and overall well-being. The Registered Dietitian, Robin Reynolds will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.
4. If the Registered Dietitian, Robin Reynolds, suspects the existence of disease, disorder, or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Physician or Naturopath about any suspected problems.
5. Should I request the Registered Dietitian, Robin Reynolds, to recommend dietary changes and/or nutritional supplements to enhance my body’s natural ability to resist and/or overcome a known disease, disorder, or condition, it is my responsibility to disclose the nature of the disease, disorder or condition and all other relevant details to the Registered Dietitian, Robin Reynolds. If I
have not previously consulted a licensed Physician or Naturopath about this disease, disorder, or condition, I acknowledge that I am directed to promptly do so. I am not to alter or discontinue treatments prescribed by a licensed Naturopath, Physician, or other licensed health professional without consulting the individual who prescribed the treatment.
6. In providing Nutrition Counselling Services to me, the Registered Dietitian, Robin Reynolds, is relying upon the truth, accuracy, and completeness of all information I have provided to her. Any recommendations I follow for changes in diet, including the use of nutritional supplements, are entirely my responsibility.
7. Robin Reynolds is in no way liable for my health or safety.
8. In consideration of my participation in the Nutritional Counselling Services, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release the Registered Dietitian, Robin Reynolds, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in the Nutrition Counselling Services, whether caused by negligence or otherwise.
9. I understand that any therapies I undertake at Robin Reynolds RD are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Robin Reynolds RD is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice; in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.
I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO THE TERMS OUTLINED ABOVE. I UNDERSTAND THIS AGREEMENT TO BE A FULL AND FINAL RELEASE OF ALL COSTS, CLAIMS, CAUSES OF ACTION AND DAMAGES OF ANY KIND ARISING FROM OR IN CONNECTION WITH THE NUTRITION COUNSELLING SERVICES.