INFORMED CONSENT & TERMS FOR NUTRITIONAL COUNSELING

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I am hiring the counselling/consulting services of Nourished Again Nutrition Registered Dietitians (RD). The appointment will provide information and guidance about health factors within my own control: my diet, nutrition, and lifestyle in order to nourish and support my health and wellness. 

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I understand that Nourished Again Nutrition does not employ medical physicians but, rather, employs Registered Dietitians. I also understand that Nourished Again Nutrition dietitians do not dispense medical advice, nor will they diagnose or treat any medical condition.

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I understand nutrition counselling is not a substitute for the diagnosis, treatment, or care of disease by a medical provider, but will provide nutritional support and nutrition education for an already diagnosed condition.

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Rather, they provide education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviours associated with eating. While nutritional support can be an important compliment to my medical care, I understand these services are not a substitute for medical care.

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In order to benefit from nutrition counselling, I realize that it is important for me to inform my physician or Nourished Again Nutrition of any changes I make in the application of my diet. It is my responsibility to report any side effects or problems immediately and to make the necessary adjustments to my treatment plan with my physician and/or Nourished Again Nutrition. I will not hold Nourished Again Nutrition responsible for any complications that result from my failure to comply with either of the above. 

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I agree to hold Nourished Again Nutrition & its staff harmless for claims or damages in connection with our work together. This is a contract between myself and Nourished Again Nutrition and I understand that it is also a release of potential liability. 

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SECURITY, DATA COLLECTION & DATA STORAGE

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I understand that Nourished Again Nutrition will keep chart notes as a record of our work together. These notes document the topics that we talk about, interventions used, and treatment plan or any other considerations that may be helpful to the dietitian's work with me.

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Medical records, personal information and history divulged in session to the dietitian will be kept strictly confidential unless I consent to sharing my medical and nutritional information with collaborating practitioners.

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Electronic systems used for data collection and/or teleconferencing will incorporate reasonable network and software security to protect the confidentiality of the client. Records will be stored within a proprietary OFFLINE database, as opposed to an online storage location. However, I understand that the benefits and risks from telemedicine, including, but not limited to, the possibility, despite reasonable efforts on the part of my dietitian, that the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons. 

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I understand that Nourished Again Nutrition is not responsible for any technical difficulties including, but not limited to, a low-bandwidth internet connection, weather-related outages and/or ISP difficulties. Nourished Again Nutrition recommends an internet connection of 5Mbps download and 1Mbps upload. More information on the exact requirements of the software can be found here.

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BILLING, APPOINTMENT RESERVATIONS & CANCELLATIONS

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The appointment time will be reserved for the client's use and will not be shared with other clients.

 

To secure and hold the appointment we do require a valid credit card number prior to the actual appointment. The appointment is not confirmed as booked in the system until a credit card is on file.

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I understand that my booking my be forfeit upon failed pre-payment. I also acknowledge that while my appointment may or may not span the entire length of the booked time-slot, it will be billed for the entire slot. 

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All credit card numbers will be stored in a local database, not within any online system, and will not be charged until the time of the appointment.

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Nourished Again Nutrition requires a minimum of 24 business hours' notice for any cancellations or changes to your appointment. Clients who provide less than 24 business hours' notice, or miss their appointment, may be automatically billed a cancellation fee of $45.

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All appointments must be cancelled via email to nourishedagain@protonmail.com

 

 

MEDICAL INSURANCE BILLING & DIRECT BILLING

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Nourished Again Nutrition does not currently offer a direct billing service. However, many extended medical insurance plans cover nutrition counselling by a Registered Dietitian. Check your plan to see what is covered for you.

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The following insurance companies/programs may offer coverage of up to $1000 annually for Registered Dietitian services:

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• Blue Cross

• Chamber of Commerce Group

• Clarica

• Great West Life

• Green Shield Canada

• Liberty Health

• Manulife Financial

• Sun Life

• Warren Shepell Employee Assistance Program

 

If your plan does not cover the services of a Registered Dietitian, save your receipts for a non-refundable tax credit. 

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