Terms of service & Disclaimer.

CLIENT - PRACTITIONER AGREEMENT

We are entering into a partnership in which we work together with the purpose of improving your health consistent with your goals. We work at your pace and develop treatment plans together based on your preferences. This agreement serves to clarify and agree upon what our relationship will entail and expectations of each other.

Nutrition Services to Be Provided

1. Angelica Kiley is a nutritionist in the state of Florida and a CNS (Certified Nutrition Specialist) candidate.  She is under direct supervision of TNC (The Nutrition Collaborative) as she gains clinical experience for her CNS and state licensure as a LN (Licensed Nutritionist).

2. Angelica Kiley at Restore Health offers nutrition counseling services in those states of the United States and internationally whereby individualized nutrition counseling is permitted without a unique license or with a Florida License. 

3. Our goal is to help you achieve the highest state of health consistent with your own goals. Nutrition can serve as an excellent adjunct to a medical doctor’s treatment, but it is not a substitute for that treatment.

4. Services offered as a part of this partnership may include education about nutrition, coaching, personalized food and dietary recommendations, lifestyle modifications, lab testing recommendations, lab testing analysis and nutritional supplement recommendations.

5. As a part of Medical Nutrition Therapy, we will perform a comprehensive nutrition assessment determining a nutrition diagnosis; plan and implement a nutrition intervention; and monitor and evaluate your progress.

6. We will provide guidance and support through nutrition education, by answering your questions, offering choices, making recommendations and coaching you through the process of change.

Client’s Role, Rights & Responsibilities

1. As a client, you play an active role in improving your health. We work at your pace, according to your preferences and within your expressed limitations.

2. In order for us to provide the most comprehensive care possible, it is your responsibility to fully disclose health and lifestyle information.

3. As service progresses, you will need to inform us of changes that occur to your treatment, including medication and health changes.

4. You have the right to respectful, courteous care, and can refuse to follow any or all recommendations provided as a result of this consultation.

5. You have the right to choose another practitioner for any reason and to request that health information be disclosed to another practitioner or health care provider.

Supplement Safety

1. The historical record and modern research indicate that herbs and supplements most often used for healthcare have a good safety record. Similarly, confirmed cases of herb, nutrient and drug interactions are rare. However, adverse events can occur after using any active substance, including allergic response. Therefore it is imperative that you disclose to us a) all medications, supplements and herbs currently in use, b) any liver or kidney disease (past or present), c) any medical conditions, d) any allergies, e) if you plan to or could become pregnant or are currently pregnant or breastfeeding.

2. As with many health-related services, there are certain potential complications, which could arise. Those complications range from discomfort through serious health concerns requiring emergency medical care. While your practitioner will make an effort to assist you in avoiding potential interactions and avoid herbs or nutrients that may interact with drugs, research is still emerging and there may be unknown interactions. Negative reactions to natural remedies may include rare allergic reactions, including headaches, itching, hives, difficulty breathing, and very rarely, even shock or death. While unlikely, clients choosing to take products could have an adverse reaction or experience a reduction or increase in the effect of medications. This can have serious consequences for some medications, such as for the control of high blood pressure, blood sugar or control of bleeding/clotting. Clients should discuss any concerns with us and your physician(s) as appropriate about any adverse effects or reactions. 

3. The probability of these complications is rare, but you are being made aware of the full range of possibilities that may occur and assume the risk of proceeding with care by signing this agreement.

4. It is important to stay within the dosage recommended. You are expected to inform your physician(s) of any nutritional supplement or herb use. Any suggestion that the effect of a drug is being altered by simultaneous use of an herb or nutritional supplement should be reported directly to all health professionals involved. Clients should let their physician know what herbs or other dietary supplements they are taking, particularly prior to surgery or other procedures. It is advisable to stop taking herbs and supplements 7-10 days before and after a surgical operation, and/or in the event of being prescribed a new medication.

5. We may recommend and/or review laboratory testing to assist with nutrition assessment. The purpose of such testing is to review for contraindications, consider possible referrals and to evaluate the body as a whole with special attention given to biochemical or physiological imbalances and toxic overload. The ordering and review of such testing is not diagnostic. Any dietary and nutritional supplement recommendation tailored to functional laboratory testing is designed to address these imbalances to support wellness and is not intended to prevent, diagnose, treat, mitigate, or cure any disease or condition.

INFORMED CONSENT

1. I have sought the nutrition counseling service of Angelica Kiley at Restore Health for my personal healthcare or for my child or children who are minors.

2. I am solely responsible for the decision to consult Angelica Kiley for nutrition counseling services.

3. I understand Angelica Kiley, MS is not a physician and therefore cannot diagnose or treat disease or prescribe drugs. If I have not already done so, I agree to consult a medical doctor for any disease or medical conditions, either for myself, or someone under my guardianship. I understand that the medical nutrition therapy/nutrition counseling I receive from Angelica Kiley at Restore Health is not meant to replace the advice of my physician, treatment plan and/or medication regimen. No aspect of a consultation should be understood as a basis to avoid any diagnostic work-up or avoid, alter or discontinue any medical treatment. Clients should have a primary care physician and other needed specialists, and follow-up with their physician to discuss modifications they intend to make to their health protocols or to change protocols as necessary. In appropriate cases, Angelica Kiley may make suggestions for nutraceuticals, including herbal remedies to support wellness or help alleviate symptoms of conditions that are known to be either self-limiting, such as headaches or digestive distress, or that that have received any necessary evaluation by a physician. Any mention of medication in the course of consultation is only for the purpose of providing a complete medication history and not to suggest any alteration.

4. Angelica Kiley recommends that you get medical clearance from your medical doctor before you partake in any of the exercise modalities that may be recommended. I understand that if I am in pain or discomfort, I should immediately seek MEDICAL TREATMENT.

5. Although prescriptions and over-the-counter medications are used when your physician deems it necessary, foods, vitamins, minerals, enzymes, herbs, and other nutritional approaches may also be chosen as therapy or as adjunctive to medical therapies. I understand it is my responsibility to ensure I inform my medical doctor(s) of all supplements/diets I will be partaking in so that they can make sure there are no contraindications to my medicine.

6. Angelica Kiley makes no representations, claims, or guarantees regarding the efficacy of nutrition counseling recommendations or that clients will experience benefit or not suffer adverse consequences. The recommendations are based upon a combination of clinical experience and knowledge of scientific and medical literature. With this information, individualized protocols may be offered and applied as either adjunctive or primary protocols for certain conditions.

7. I have reviewed this document, including services to be provided, cancellation policy and fees, email policy, refund policy, my responsibilities as a client and the safety of supplements.

8. I have had the opportunity to ask Angelica Kiley questions regarding the proposed services, this consent form, and other pertinent information and have received satisfactory explanations. I understand that I am free to discontinue service(s) at any time.

9. By signing this informed consent, you agree to and assume the risk of any nutritional changes or use of supplements you undertake. You have the right to have this consent reviewed by your lawyer before accepting any services from our office.