Informed consent

Informed consent for Vitamin D Therapy, Acupuncture and Complimentary Natural Diet & Nutritional Medicine for Autoimmune, Inflammatory and Lifestyle Diseases.

I have sought nutritional/medical care from Dr. Reshma Quadros and Dr. Chintan Dalal for my autoimmune, inflammatory & Lifestyle disease/s.

I have chosen to do so of my own free will.
I am aware that nutritional medicine refers to a system that uses vitamins, minerals, enzymes, and herbs along with gut therapy to detoxify.

I realise that this integrated approach to medical therapy may not be as rapid as pharmaceuticals or surgical treatment and that it may require more commitment and effort from me than the simple administration of a symptomatic medication for each complaint.
I have been informed and am aware that it is up to me to follow the recommended treatment program faithfully if I am to attain the maximum possible benefits.

I understand that in this system, Vitamin D as Therapy is being used to treat autoimmune,inflammatory & lifestyle disorders by doctors worldwide trained under Prof. Dr. Cicero Coimbra from Brazil.
Dr. Reshma Quadros and Dr. Chintan Dalal are trained under Dr. Renu Mahtani, who is also a pioneer within this field from India.

They have adequately explained to me about this method of treatment through videos, brochures, links to published case studies and direct or online conversations with their team of doctors.

Further, I have been specifically informed that –

  • Vitamin D will have to be taken regularly in doses higher than what is generally advised for prevention, to get the blood levels near the upper limit of sufficiency ie 100 ng/ml. Or above. 
  • Vitamin D toxicity is not seen despite vitamin D level being >100 ng/ml, provided hypercalcemia (higher than normal blood levels of ionized calcium) can be prevented.
  • Vitamin D therapy will be monitored based on PTH (Intact) and Ionized Blood Calcium levels done periodically.
  • The requirement of vitamin D is higher for those who are obese and dark skinned.
  • Many individuals with multiple autoimmune conditions need more vitamin D due to higher vitamin D resistance. The vitamin D levels here can go >150 ng/ml, as more vitamin D will be needed for its action of immune-modulation. Calcium monitoring will be done periodically for prevention of hypercalcemia.
  • I have been informed to stop all calcium supplements while on this protocol to prevent calcium overload and toxicity. I am aware that I have to be on calcium limited diet (based on the blood levels) and I take responsibility to do as advised.
  • This treatment will have to be a long-term treatment to maintain the benefits, where dose will be changed based on the response. This therapy is personalized and needs fine tuning to suit my requirements.
  • It is my responsibility to maintain contact with the doctor / team as advised. If I fail to do so, the consequences are my responsibility.
  • The benefits of this therapy are much greater if I follow a healthy lifestyle (non-smoking, daily moderate exercise and emotional balancing). I am aware that stress can aggravate or precipitate my symptoms.
  • I understand that it is my option to stop, at any time, this treatment after informing about my decision.
  • I understand my treatment may include regular Acupuncture, Moxibustion, Red Light Therapy, Pranayam and Breathing techniques.
  • I understand and have been informed that Acupuncture is highly effective form of treatment, especially in treating Chronic Pain, Neuromuscular and Spinal conditions the effectiveness of it depends person to person. I have been further informed that, I will have to systematically follow through the whole line of sessions as the therapy does not work as a One off trial.
  • I have been informed that Acupuncture is a Safe procedure, but can have momentary effects like Bruising, minor bleeding, tingling at the site of the Needling area, and can last for a few days.
  • I have been informed and have verified myself visually, that Fresh Disposable Filliform Needles are used to perform Acupuncture.
  • I have been informed by way of reading this entire consent form in detail the various aspects of this approach to therapy and treatment for my Chronic Conditions.
  • I have been informed that this Form of Therapy and Treatment is NOT a Replacement for Acute / Emergency Medical Interventions. And that this Clinic DOES NOT attend Emergency Calls, Suggestive Treatments etc in case of Medical Emergencies.
  • I have been informed to reach out to Local Physicians for Medical Emergencies and Acute disorders.
  • While I understand that there have been no figurative warranties made to me, I desire to undergo this treatment.
  • I acknowledge that I have had the opportunity to ask any questions of my physician with respect to the proposed therapy and all of my questions have been answered to my full satisfaction.
  • I hereby give consent to undergo this treatment for my autoimmune, inflammatory & lifestyle condition, with vitamin D and other nutritional supplements and acupuncture as needed.

I certify that I have read and understood the above.

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    You agree Submitting the Form Online, Shall be Considered as Duly Signed by the Patient and Consenting Witness / Family member.

    Name Printed as per Submission will be considered as Signed Consent to view, and use data submitted for Clinical research purposes.

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