© Copyright NATROLIVE

TERMS OF ENGAGEMENT (CONFIDENTIAL)

Informed Consent to receive Nutritional Therapy with 

Olivia Smart, MA Cantab, dip CNM, mANP, mGNC

Nutritional Therapy is practiced by non-medical professionals and is complimentary to other regulated forms of healthcare in England. Consultations with a nutritional therapist include completing a client questionnaire and food diary, taking a detailed case history, discussing diet and lifestyle, creating a nutrition plan with lifestyle suggestions, recommending supplements and testing (if relevant) and following up on results and progression of your health. 

While the best course of action is continually sought for the patient, there always exists the possibility of side effects, adverse reactions or inefficacy of treatment.  Olivia Smart holds your safety and well-being as her top priority in the management of your case and welcomes all questions or concerns you may have.

In signing below I acknowledge that: 

1. Olivia Smart has in no way suggested that my being under her care should prevent me from seeking treatment from any other healthcare practitioner.

2. Olivia Smart will strive to deliver the safest and most effective interventions for my case, however there is still the possibility that side effects or adverse reactions might occur, or that therapeutic benefit may not be achieved. I will not continue with recommendations beyond the time frame of the plan, unless agreed by Olivia Smart, to avoid any adverse reactions.

3. I will inform Olivia Smart of all medical conditions I have been diagnosed with, symptoms I am experiencing, and medications I am taking/have taken in the past. I will also inform her of any new medical conditions or symptoms or medications should they arise. This includes herbal medicine, over the counter medication and supplements.

4. I will inform Olivia Smart if I am pregnant or breastfeeding.  I will immediately inform her should I become, or plan to become pregnant or if I begin, or plan to begin to breastfeed.  

5. I will inform Olivia Smart if I do not understand any given part of the recommendations given to me or if I am uncomfortable with any aspect of my care.

6. All of the information I provide to Olivia Smart is protected by General Data Protection Regulations and is confidential unless disclosure is required by law.  

7. My case information may be used for the publication of case reports or case studies. Any information concerning my identity will be excluded from publication, thus maintaining my anonymity. 

8. I am free to purchase any products recommended by Olivia Smart for my treatment from a vendor of my choosing, being under no obligation to purchase products from Olivia Smart/natrolive directly.  

9. I have read and understand the natrolive fee schedule and cancellation policy (below).

10. I will ensure that Olivia Smart receives my completed client questionnaire and food diary at least 24 hours before my consultation.

 I, the undersigned, declare that I have read and understood the information presented above and that I authorize and consent to my present and future use of the nutritional therapy services by Olivia Smart/natrolive.  I understand that I may withdraw this consent at any time.  

_____________________________                          __________________________

Client Name (Print)                                                            Date

_____________________________                          __________________________

Client Signature                                                      Olivia Smart, natrolive

Nutritional Therapy Consultation Fee Schedule

Initial Consultation - £150

Follow-up Consultation - £125

Nutrition plans will only be sent once payment has been received

Cancellation Policy: if you miss an appointment or it is cancelled within 24 hours, the full cost of the consultation will be liable.