Please read the following information carefully. By signing or checking the applicable boxes, I confirm that I understand and agree to the terms below.
1. Nature and Purpose of Ayurvedic Consultation
I understand that the services provided by Dua Ayurveda are intended to provide education, guidance, and wellness support based on the principles and practices of Ayurveda.
I understand that an Ayurvedic consultation is intended to help me learn about lifestyle, nutrition, daily routines, and other Ayurvedic approaches that may support my general health and well-being.
I understand that Ayurvedic consultation and wellness services are not intended to replace medical care provided by a licensed physician or other regulated healthcare professional.
2. My Participation
I voluntarily choose to participate in Ayurvedic consultation and wellness services provided by Dua Ayurveda.
I understand that the purpose of these services is to support my interest in improving my overall health, wellness, lifestyle, and balance of mind and body.
I acknowledge that any recommendations provided during an Ayurvedic consultation are intended as educational and wellness guidance.
3. Medical Care and Medications
I understand that I may seek advice or treatment from a licensed physician or other qualified healthcare professional at any time regarding an existing or newly developing medical condition, disease, symptom, or health concern.
Dua Ayurveda encourages clients to maintain appropriate and regular medical check-ups with a licensed healthcare professional of their choice.
I understand that any prescription or other medication that I currently take, or may take in the future, should be used strictly according to the instructions of my prescribing physician or qualified healthcare professional.
I understand that Dua Ayurveda does not advise me to start, stop, change, or alter the dosage of prescription medication. Decisions concerning prescription medications, including dosage changes or discontinuation, should be made with my licensed physician or prescribing healthcare professional.
4. Scope of Ayurvedic Services
I understand that, as part of an Ayurvedic consultation, Dua Ayurveda may provide an Ayurvedic assessment and educational recommendations relating to areas such as:
- Diet and nutrition
- Lifestyle and daily routines
- Ayurvedic wellness practices
- Herbal and traditional Ayurvedic approaches
- Physical activity and exercise
- General health and wellness practices
I understand that these services are not a substitute for diagnosis, emergency medical treatment, or pharmaceutical medical care.
I acknowledge the importance of maintaining appropriate communication with my physician and other healthcare providers and of obtaining professional medical advice when necessary.
5. Voluntary Participation and Release
I confirm that I am seeking and participating in Ayurvedic consultation, wellness services, and/or bodywork provided by Dua Ayurveda voluntarily and of my own choice.
I understand the nature and general purpose of the services being provided to me and have had an opportunity to ask questions about the services.
To the extent permitted by applicable law, I release and hold harmless Dua Ayurveda, its owners, practitioners, consultants, therapists, staff, and representatives from claims or liabilities arising from my voluntary participation in Ayurvedic consultation, wellness services, and bodywork, except to the extent that such liability cannot legally be excluded or waived.
I understand that individual responses to Ayurvedic recommendations, herbal preparations, massage, bodywork, and other wellness practices may vary from person to person.
6. Client Information and Confidentiality
I understand that information I provide to Dua Ayurveda, including my health history, consultation information, assessment information, treatment records, and progress notes, will be treated as confidential.
Such information will not ordinarily be disclosed to another person or organization without my authorization, except where disclosure is permitted or required by applicable law.
I understand that I should provide accurate and complete information relevant to my consultation and inform the practitioner of any significant changes in my health, medications, allergies, pregnancy status, or other circumstances that may be relevant to the services provided.
7. Cancellation and Rescheduling Policy
I understand and agree to the following cancellation and rescheduling policy:
- Less than 72 hours’ notice: A fee equal to 50% of the applicable consultation fee may be charged.
- Less than 24 hours’ notice: A fee equal to 100% of the applicable consultation fee may be charged.
Exceptions may be considered at the discretion of Dua Ayurveda in appropriate circumstances.
8. Client Acknowledgement
By selecting the acknowledgement below, I confirm that:
I understand that I am voluntarily requesting Ayurvedic consultation and wellness services and that I have had an opportunity to ask questions before providing my consent.