Consent Form- Tiffany Wyse

Please read the following and sign below.

Clinical Naturopathic Medicine is a distinct form of health care that combines modern scientific research with traditional and natural forms of medicine. It is the art and science of health investigation, treatments and preventative care through the use of natural therapeutic methods and substances.

Clinical Naturopathic Medicine is based on the belief that all living organisms have an innate healing capacity. This is the force within each of us that is continually active in its effort to move us toward health and wholeness. It is called the Vis Medicatrix Naturae, the vital force, Viriditas, or the healing power of nature.

Naturopathic Doctors use safe, gentle, non-invasive therapies that encourage our inherent self-healing processes to restore health. Therapies used include botanical medicine, nutrition, acupuncture, homeopathy, auricular medicine and lifestyle counseling.

Botanical medicine is a plant-based medicine that involves the use of herbal teas, tinctures, decoctions (strong teas), capsules, and other forms of herbal preparations to assist in maintaining and promoting healthy living. Naturopathic Doctors are professionally trained; knowledgeable in both the historical uses of plants and their modern pharmacological mechanisms.

Individual diets and nutritional supplementation are recommended to address deficiencies, treat disease processes, and promote health. There is an ever growing body of knowledge that supports the use of whole foods and nutritional supplements in the maintenance of health and the treatment of disease. The benefits may include increased energy, increased gastrointestinal function, improved immunity, and general wellbeing.

Asian medicine includes the use of acupuncture, Eastern herbs and dietary changes to eliminate disease and balance body functions. Acupuncture refers to the insertion of sterilized disposable needles through the skin into underlying tissues at specific points on the body. Eastern herbs may be given as pills, tinctures, or decoctions to be taken internally or used externally as a wash. Dietary advice is based on Asian medical theory.

Homeopathy is a form of medicine based on the Law of Similars. It uses uniquely prepared remedies prescribed to match precise symptoms of the person who is ill. Homeopathic remedies, made from nontoxic extracts of plant, mineral, or animal substances, promote biological and physiological healing.

Biotherapeutic Drainage is a unique form of homeopathy aimed at supporting the body’s natural routes of elimination and enhancing the cellular function of the organs and tissues within the body. Biotherapeutic Drainage is a non-invasive treatment method employing non-toxic, natural remedies, taken orally.

Auricular Medicine is an energetic reflex technique in which the pulse and filters are used to detect possible blockages to self-healing in the body. Specific points may be found on the ear that correspond to the location of imbalance within the body.

An ear acupuncture treatment or corresponding remedies may be given to address the imbalances.

Mental, Emotional and Lifestyle Counseling are essential to the practice of natural medicine. In almost all cases there is a mental/emotional component that needs to be addressed so the body can heal itself. We take the time to listen and to help you find the solutions.

Lifestyle counseling involves making suggestions such as drink more water, go to sleep at a reasonable hour, and other suggestions otherwise known as the basic treatment guidelines.

We are here to teach, support, encourage and coach you to make healthy lifestyle choices.

Hydrotherapy refers to the use of hot and cold water applications to improve circulation and stimulate the immune system.

There are some slight health risks to treatment by Naturopathic Medicine.

These include but are not limited to:

  • Aggravation of pre-existing symptoms
  • Allergic reactions to supplements or herbs
  • Pain, bruising or injury from venipuncture or acupuncture
  • Fainting or puncturing of an organ with acupuncture needles
Acknowledgment of Consent

In order to clarify that Tiffany Wyse’s position as a health care practitioner, and the mutual responsibility in your health care, please sign this statement of acknowledgment.

  1. That you understand Tiffany Wyse is a Naturopathic Doctor and not a Medical Doctor; that noninvasive, natural methods of assessment and treatment of body dysfunctions and body optimization are used.
  2. That you understand that the methods utilized by Tiffany Wyse have a proven clinical foundation, yet may not be accepted practice by standardized orthodox medicine.
  3. That you understand that the treatment and/or referral to other health practitioners is based upon assessment of your health revealed through personal history, physical examination, laboratory tests and other appropriate methods of evaluation.
  4. That you understand that Tiffany Wyse has the right to determine which cases fall outside of her scope of practice as a Naturopathic Doctor, in which event an appropriate referral will be recommended.
  5. That you are not an agent or any private or government agency attempting to gather information without so stating your intentions.
  6. That you are accepting or rejecting this care of your own free will.
  7. That you understand that the ultimate responsibility for your health care is your own, and that Tiffany Wyse supports you in this. She reserves the right to discontinue services where it is apparent that your expectations and what he provides are not in agreement.
  8. That you understand that your written permission is necessary to release your file to anyone else and that information is treated confidentially.
  9. That you are aware that several Extended Health Care Insurance Plans provide additional coverage for Naturopathic Care. Please check your policy and check with us.

FEE SCHEDULE effective September 15th, 2018

Initial consultation (90 minutes)

Adult                                                              $195
children*, students**, seniors                   $175

Extended follow up consultation and physical exams (90 minutes)

Adult                                                               $180
children*, students**, seniors                    $160 

Subsequent consultation (60 minutes)

Adult                                                               $140
children*, students**, seniors                    $120

Subsequent consultation (45 minutes)

Adult                                                               $110
children*, students**, seniors                    $ 95 

Short consultation (30 minutes)

Adult                                                               $ 95
children*, students**, seniors                    $ 80

ACUTE consultation  (15 minutes)      $ 40

 

Telephone consultations                     $ 50/each 15 minutes

Home visits (60 minutes)                   $160/hr plus $2/minute travel time

Doula package:   2 pre-natal visits, birth attendance, 1 post-natal visit & phone calls pertaining to any birth related questions.                                                $1600

 

*Children: less than 16 years of age
** Students: in school full-time with valid photo id card

Fees are payable by VISA, MASTERCARD, debit, cash or cheque at the end of each visit. Any prescribed herbal tinctures, supplements or homeopathic remedies are not included in the above fees.

Please note that these fees are not covered by OHIP.

Most extended health care plans cover all or part of Naturopathic visits.Please contact your employer or insurance agent to inquire about naturopathic coverage.

  • Signature of Patient (Parent/ Guardian)

Medical Herbalism Course Beginning January 10th, 2019. For out of Toronto students, we will live stream on ZOOM. Payments for the course are done by e transfer to susan@viriditasherbalproducts.com. Please use password MHC