Disclosures, Authorization, Records Release & Consent
 

Thank You for choosing to allow us to work with you. Arrowhead HealthWorks™ is a non-medical Wholistic Integrative Wellness Center and Web based business based in the Lake Arrowhead area of S.Calif. We may utilize licensed and non-licensed doctors, practitioners and therapists dedicated to a wholistic approach to healthcare (Chiropractic; Naturopathic; Medical, Estheticians; Massage Therapy, etc.). We also have a highly screened and very specific physicians & dental network we refer to which we believe to be high quality and safe as well as ethical in their business practices. We're affiliated directly with Europa Institute of Integrated Medicine in Tijuana, Mexico (Jeff Freeman, M.D. & Sonia Rodriguez, M.D.) as well as maintain a network of qualified Integrative and Wholistic Practitioners and specialists we refer to.

Carolyn Bormann, N.D./N.P. is the founder and owner as well as a Naturopathic Practitioner (as opposed to a licensed NMD/ND which is a Naturopathic Medical Doctor). She received her N.D. degree from Clayton College in 1995. She has worked in the allopathic medical field since 1974 and has personally used and worked in "Alternative" Medicine arena and since 1988. She is Certified & Board Elligible in BioOxidative Medicine as well as trained in Medical Hyperthermia, Phlebotomist/Lab Tech, and is continually taking classes and learning new modalities and therapies. She provides private consultations, professional consultations to physicians and therapists, nutrition, enzyme therapy, sauna therapy, lymph therapy, drugless pain management, herbal remedies, homeopathics, natural hormone balancing, nutritional and biochemistry analysis, etc. She likes to bring in specialists to help like Dr.Marvin McCormick who is a gifted Chiropractor and Christian Medical Intuitive and Quantum Energy Specialist.

We generally provide therapies, services, and consultations which are non-medical in nature and therefore, no insurance billing is possible. Should medical intervention be required, we choose from these physicians and therapist first unless you have a current physician who is willing to work with us and is trained in the use of Alternative Medicine/CAM methods.

Our clients are typically independent thinkers and highly motivated responsible self-starters. They want to be actively involved in their health care and not passive. Therefore, it is important that you understand that in the event that you choose to utilize any of our services, suggested supplements, food regimens or programs suggested and/ or utilize our referral recommendations to other facilities or professional services that we believe could be helpful, without the involvement of a licensed health professional / medical doctor, you are prescribing for yourself, which is your 9th Amendment Right, but we assume no responsibility or liability for the outcome. Healing is multifaceted as is life and there are no simplistic answers.

All known risks and benefits of any product, procedure, dietary changes, or tests will be explained to the best of our knowledge and we will take as much time as necessary to make sure you understand everything so that you can make intelligent decisions, and we respect your right to self determination. No product or other purchases are required to utilize our services.

The outcomes and information gleaned through our consulting, therapies or services of Arrowhead Healthworks or it's affiliates or therapists are not to be misconstrued to be either directly or indirectly dispensing medical advice for the cure or mitigation of any disease or condition. Neither is it an attempt to diagnose or prescribe being that is only the realm of licensed medical doctors. We are not a Medical Practice. We're also required to inform you that because of that fact, we do not carry malpractice insurance.

I, (type name) and I am voluntarily seeking the services of Arrowhead Healthworks™ and its practitioners, doctors, therapies and services or products. I have read and understand the above statements and conditions. I agree and consent to work together proactively to build my health. I understand that I have options to consult with both licensed and unlicensed practitioners and therapists at my discretion as part of exercising my 9th Amendment Right to Self Determination, and that this is not a licensed medical practice but your services are designed to provide health building information and products and therapies and should I choose to use any of this information for self healthcare, I agree to hold Arrowhead Healthworks and all of its therapists and doctors harmless from any present of future liability.

CONSENT & RECORDS RELEASE
I am 18 years old or older. I give permission and consent to procure and review my healthcare records, medical records, Lab and Xray or Diagnostic reports, and any other necessary paperwork required to assist you in the assessment of my current health status and in helping me determine what services may be for my benefit. I give permission for you to share pertinent medical and any other information necessary with members of your therapy team as you deem best to help me in my quest for good health.
 
To the best of my knowledge, these statements are true and factual. I understand that my personal information will be held confidential and not made available for sale or use for marketing lists, internet databases or anything else.
I am over the age of 18 and able to make my own healthcare decisions. I am the parent of the above minor patient.
I have Power of Attorney for making healthcare and treatment decisions for the above named patient who is a minor or unable to make medical decisions anylonger.
(we'll need a copy of the notarized POA for our files)
 
 Patient Name:
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(Patient Virtual Signature )
(Guardian / Power of Atty Virtual Signature)
(Today's Date)


©1994-2014Arrowhead HealthWorks ™ P.O.Box 3668, Crestline, CA 92325
(909) 338-3533 / FAX (909) 338-3743
E-mail: dbormann@arrowheadhealthworks.com *ARROWHEADHEALTHWORKS.COM