location_on In-Clinic (Offline) videocam Video / Voice (Online)

HOMOEOPATHIC TREATMENT CONSENT FORM

Homoeopathy Wellness Centre

INFORMED CONSENT FOR HOMOEOPATHIC TREATMENT

I voluntarily consent to undergo Homoeopathic treatment under the care of Dr. Hiral. I understand and acknowledge the following:

• Homoeopathy is a recognized system of medicine that aims to treat the individual holistically based on symptoms, constitution, and clinical assessment.
• The doctor has explained to me, in understandable language: The nature of my illness/condition, the proposed Homoeopathic treatment, and the expected benefits and limitations of treatment.

I understand that:

• Response to treatment may vary from person to person.
• No guarantee or assurance regarding complete cure, speed of recovery, or specific outcome has been made.
• Some chronic conditions may require prolonged treatment and regular follow-up.

I agree to provide accurate and complete medical history, including: Previous illnesses, Ongoing treatments, Allergies, Medications currently being taken, and Pregnancy status (if applicable).

I understand that Homoeopathic medicines should be taken strictly as advised by the physician. I understand that in emergencies or conditions requiring immediate conventional medical/surgical intervention, referral to appropriate medical services may be necessary.

I understand that I may ask questions regarding my treatment at any time and that my doubts have been addressed satisfactorily. I consent to clinical examination and maintenance of medical records for treatment purposes while maintaining confidentiality as per professional ethics.

I understand that I may discontinue treatment voluntarily at any time.

ADDITIONAL CONSENTS:

• For Online Consultation: I consent to consultation through telephone/video/online platforms and understand its limitations.

• For Follow-up Communication: I agree to receive follow-up reminders and treatment-related communication via phone/WhatsApp/SMS.