PLEASE READ BEFORE PRESSING SUBMIT
By Submitting this form, you consent for Caroline O'Hagan to collect and store your personal information as part of your case file. Your health information will be collected only as necessary for the proper and effective treatment of your condition. This information will be treated with strict confidence, and unless legally obliged to do so, the information will not be released to a third party without your written permission.
You declare all answers and statements contained in this Personal Health History form are true and complete to the best of your knowledge. You understand that a naturopath does not diagnose illness, disease or any other mental or physical disorder and does not prescribe medical treatment. You understand that it is important for your naturopath to be aware of all past and present medical conditions, as well as any other relevant information that is necessary to for her to form a holistic assessment of your case. You will ensure that you have read the above statements and you will inform your naturopath of any changes to the information provided within this form.
You also acknowledge that your Naturopath is only your guide on your healing journey. You must be prepared to make appropriate changes and implement the health care plan that is prescribed to you, in order for Naturopathic treatment to be successful. Compliance with instruction is vital, dietary and lifestyle changes that are suggested are important - supplementation alone is rarely enough.