Patient consent form
(for confidential file only)

 
PATIENT  (name and address)

            Date of birth

            General Practitioner

I have received the leaflet outlining the work of the Whole-Person Clinic and I understand
the aims of the Clinic.

I realise that this Clinic is following a new way of thinking in health care which seeks to explore
and improve the person’s internal defences and ability to cope with illness.

I understand that this Clinic will seek to integrate health care to fully explore issues which are
physical, psychological (both thinking and feeling), social and spiritual.

I understand that all treatments will be fully discussed and agreed by me before they begin.

I realise that I can withdraw at any time and this will not disadvantage my normal medical care
which can proceed alongside this Clinic as my usual doctors think fit.

I give my consent to this programme of help, and have had the opportunity to have all my
questions answered.

Signed (patient)

Signed (Medical Attendant)

Date