This consent form ensures that you are fully informed about the Functional Medicine services provided at Dr Gayetri & Associates. It outlines your rights, responsibilities, and our policies on treatments, data protection, cancellations, and communication. Please read this document carefully and tick where necessary to confirm your understanding and agreement.
Dr Gayetri & Associates provides recommendations based on Functional Medicine principles. No explicit or implied guarantees are made regarding outcomes, and patients assume full responsibility for the implementation of these recommendations.
We will also frequently work alongside and communicate with other medical and allied health professionals involved in the patient’s care to explain any therapy or protocols that have been provided.
Clinicians may consult with colleagues, preceptors, or student residents regarding patient care. Patients have the right to decline their involvement.
2. Understanding Functional Medicine
Functional Medicine is an evidence-based, patient-centered approach that aims to identify and address the root causes of health concerns through:
- Diet & Nutrition
- Physical Movement
- Mental Well-being
- Lifestyle Adaptations
- Functional Testing & Supplements
Functional Medicine is relevant for individuals with chronic conditions, as well as those looking for support to enhance their health and well-being.
Functional Medicine Doctors consider each individual to be unique and recommend personalised nutrition and lifestyle programmes rather than a ‘one size fits all’ approach.
Functional Medicine is NOT a substitute for conventional medical care. Patients should continue consulting their GP for any ongoing or acute medical concerns.
In the event of any dispute arising from the services provided, both parties agree to resolve matters through mediation or binding arbitration under UK law before pursuing legal action.
Patients acknowledge that treatments, including dietary and lifestyle modifications, supplements, and functional medicine therapies, may have risks, including symptom exacerbation, allergic reactions, or interactions with existing medications. Patients are responsible for informing the clinic of any adverse reactions.
Patients must inform the clinician if they are or suspect they may be pregnant, as certain treatments, supplements, or diagnostic tests may pose risks during pregnancy.
3. Your Responsibilities as a Patient
By engaging with our services, you agree to:
- Inform your GP of any Functional Medicine treatments or supplements you take.
- Disclose any medical diagnoses, medications, and supplements you are using.
- Contact your practitioner if you have questions about dosages, reactions, or adjustments.
- Schedule an appointment if you require further consultation instead of relying on emails.
- Refrain from recording consultations without written permission.
4. Consultation, Fees & Cancellation Policy
- 48-hour notice required for appointment changes.
- Sessions may be re-scheduled by contacting Dr Gayetri & Associates by email to consult@drgayetri.co.uk or call us on 0207 112 8831.
- Cancellations within 48 hours or same-day non-attendance will result in a £250 cancellation fee.
- Please bear in mind that we will typically see only 2-3 patients a day, and a last-minute cancellation is not often possible for us to fill.
- Patients who reschedule or miss more than two appointments within six months may be required to prepay in full for their next appointment.
Once a programme has commenced, refunds are not available for completed consultations, services rendered, or preparatory work undertaken. Any cancellations made after the programme start date will be assessed on a case-by-case basis, with deductions for work completed.
5. Communication & Follow-Ups
- General questions or patient queries between appointments will be addressed during your next consultation to ensure comprehensive and safe medical advice.
- To maintain patient safety and adhere to professional guidelines, we do not provide medical advice via email outside of scheduled consultations.
- If you require urgent clarification, we recommend booking a follow-up consultation or a 15-minute video appointment which costs £79.
- Short queries requiring less than 5 minutes of response time may be answered within 72 hours.
- If an email response requires review of your medical records, a fee of £49 per 15 minutes will apply.
- This clinic does not provide emergency medical services. If you are experiencing an acute medical emergency, please contact 999 or visit your nearest A&E.
6. Data Protection, GDPR & Confidentiality
6.1 Data Storage & Security
- Your personal and medical information will be stored securely in accordance with GDPR regulations.
- Records are retained for 7 years for adults and until age 25 for minors.
6.2 Data Sharing & Consent
- We may need to share information with your GP, Functional Testing providers, or third parties involved in your care.
- Your personal data will only be shared with third parties necessary for your treatment.
- You may request an opt-out from data sharing by emailing us on consult@drgayetri.co.uk, where legally permissible, but this may impact the availability of some services.
7. Supplements & Functional Testing
7.1 Supplements
- Supplements are NOT included in consultation fees.
- We recommend only high-quality, research-backed supplements. However, you are not obligated to purchase from our recommended sources.
- While we may recommend supplements, patients assume responsibility for their purchase, use, and any interactions with existing medications. Please consult your GP before starting any new supplement regimen.
7.2 Functional Medicine Laboratory Testing
- Functional medicine tests assess nutritional, biochemical, and physiological imbalances to support treatment decisions.
- These tests do not diagnose disease and should be used alongside conventional diagnostic methods recommended by your GP.
- While results provide insights into health imbalances, interpretations may vary among healthcare providers. Please discuss any concerns with our doctors.
8. Video Consultations & AI in Documentation
8.1 Whereby Video Consultations
- The video and audio communication in a Whereby room is only visible to participants inside the room. No other user can listen in unless they are present and visible to all participants.
- Because the room URL is a public link, others may enter if it is unlocked. We recommend locking the room by clicking the Lock button to prevent unauthorised access.
- We will never store any media sent between participants. If the “Recording” feature is used, it is client-side only, and the user is responsible for obtaining consent and storing recordings in compliance with regulations.
- Patients who receive remote consultations agree to maintain direct contact with an appropriate licensed healthcare provider.
8.2 Security & Privacy
Calls use encrypted transmission (DTLS-SRTP) for security, though streams may be decrypted and re-encrypted when passing through video routers.
- Peer-to-peer connections may be used where network conditions allow, ensuring end-to-end encryption.
- While we implement technical security measures, internet-based communication is not 100% secure, and we cannot guarantee absolute confidentiality.
8.3 AI in Documentation
- As part of our efforts to enhance efficiency and accuracy, we may use Artificial Intelligence (AI) tools to assist in creating, organizing, and refining consultation notes and medical reports.
- AI is strictly used for administrative support and does not replace clinical judgment, medical diagnoses, or treatment planning. All aspects of patient care remain the sole responsibility of the practitioner.
- AI-processed information is handled with strict confidentiality in full compliance with data protection laws and our clinic’s privacy policy.
8.4 Responsibilities
Client Responsibilities:
- Ensure privacy by closing other programs, avoiding distractions, and using headphones for increased confidentiality.
- Be online five minutes prior to the scheduled consultation in a quiet, private space.
Practitioner Responsibilities:
- Ensure a private, password-protected network for consultations.
- Eliminate distractions and technical disruptions where possible.
- If a call is disrupted, the practitioner will attempt to reconnect or reschedule if necessary.
9. Communication & Marketing Preferences
9.1 Newsletter & Email list
- We automatically add all new clients to our email list to receive a monthly newsletter containing insights on nutrition, health, lifestyle tips, recipes, eBooks, and exclusive offers.
- You may unsubscribe at any time by selecting the ‘Unsubscribe’ button at the bottom of emails.
- Or, if you prefer not to receive marketing emails, you can withdraw your consent at any time by emailing consult@drgayetri.co.uk.
- Patients acknowledge and agree to be contacted via phone, email, voicemail, or SMS for matters related to their care.
9.2 Case Studies & Educational Use
- We strive to improve our practice through professional development, which may involve sharing anonymised case studies for educational purposes.
- These case studies may be used in clinical supervision, online forums, lectures, and medical publications.
- Your name, address, and contact details will never be shared.
10. Legal & Liability Disclaimer
- Functional Medicine is an individualised approach, and while it aims to improve health, results vary from patient to patient. No guarantees, explicit or implied, are made regarding specific treatment outcomes.
- Patients are responsible for following agreed-upon recommendations and informing their GP of any significant health changes. It is their duty to seek conventional medical advice when necessary.
- This practice does NOT provide emergency medical care. For urgent issues, contact 999 or your GP.
- Dispute Resolution: If a dispute arises, both parties agree to first pursue mediation. If unresolved, legal proceedings will be governed by UK law.
The clinician cannot anticipate or explain every possible risk or complication, and the patient willingly relies on the clinician’s best judgment within their professional scope.