Consent to Testing and Assessment with Nutritional Supplements Recommendations.

I authorize David Epstein, D.O. and such physicians, associates, assistants and other personnel of the Second Opinion Physician chosen by him or her to perform the following: Hormonal Assessment and Supplements Recommendation.

I understand that that the Second Opinion Physician doctor (SOP doctor) offers a set of diagnostic tests plus an Assessment with Supplements plan. SOP doctor is providing these results and recommendations for the purpose of supporting patient in seeking specialized protocols such as those taught by Walsh Institute and Millenium Health Care that may not otherwise be available to me by my local or primary care practitioners.

“Second Opinion Physician or my SOP Doctor may encourage me to find the recommended supplement at the website BiotypeNutrients.com. The site was produced as a resource to physicians and their patients for locating specific supplements and top brands that have ingredients and dosages that are aligned according to the protocols offered for individuals with differing needs. Biotype Nutrients is owned by Second Opinion Physician P.C. and the products are sold at the MAP -Manufacturers Advertised Rate. David Epstein is the owner of Second Opinion Physician. SOP Doctor has made it clear to me that there are other sources for similar top quality professional brands offered on Biotype Nutrients in local stores and online.”

SECOND OPINION: I have been offered the opportunity to seek a second opinion concerning the proposed treatment from another physician with credentials from the A4M or any physician of my choosing.

LIMITATIONS OF MEDICAL CARE: In all cases, SOP is not taking responsibility for care regarding ongoing medical health. I have been advised that this information will be shared with my personal physician for primary care management in consideration of my overall health picture and a face to face evaluation plus vital signs testing. My primary care doctor shall continue to provide all of my standard and continuous medical care. I hereby authorize the doctor to speak directly with my Primary Care physician when medically necessary regarding my past and present medical care and treatment. My personal physician shall continue to provide all of my standard and continuous medical care.

 

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