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Patient Consent Form

Please carefully read the consent to treatment document below. Once you have done so, if you are clear on the consent you are giving, and happy to provide your consent, please submit your details and signature in order to confirm your consent. If you have any questions at all, please do not hesitate to book in a free nurse consultation or reach out to us at support@thefunctionaldoctors.com.au and our team will be glad to help

Please click on the below links to read and acknowledge the enclosed information before providing your consent:

✔  General terms of service – Patient agreement

✔  My compliance obligations

Off label medication, compounded medication

✔  Risks & Benefits HRT

✔  Risks & benefits of Weight Loss Therapy

✔  Risks & benefits Peptide Therapy

 

I have been provided with, and understand, possible implications, meanings of written information, my obligation, and responsibilities for treatment of one of the following:  Hormone Replacement, Peptides, Medical Cannabis, Weight Loss and Low Dose Naltrexone.

 

✔  I have been informed of, and understand, potential risks, benefits, and options to alternative treatments.

✔ I have been provided with adequate information to make an informed decision and can decline to consent if I wish.

✔ I understand any questions, queries or clarifications can be directed to The Functional Doctors through the website www.thefunctionaldoctors.com.au, or by email at support@thefunctionaldoctors.com.au or by phone 1800 370 690.

✔ I understand that I have the right to not consent to all treatment by The Functional Doctors, including, but not limited to, hormone replacement therapy, peptide therapy, weight loss therapy, medical cannabis therapy. I have adequate knowledge upon which to base an informed consent.

✔ I have read and understand this form, and its contents, and consent to this treatment.

I hereby affix my signature to this authorisation for this proposed treatment.

✔ I accept financial liability of my proposed treatment and care

By providing your information and signature below, you confirm that you have read and agree to the terms of service provided by The Functional Doctors.

Thank you for confirming your consent. If you have any further questions, please book in for a free nurse consultation or contact our team at support@thefunctionaldoctors.com.au

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