General terms and conditions regarding Dr Osborn’s consultation/coaching for obsessions and compulsions
By accepting this agreement for Dr. Osborn to consult/coach me, I agree to the following terms and conditions:
1) I acknowledge and understand that the information/suggestions provided by Dr. Osborn do not constitute medical advice, services or treatment. By accepting the terms of this agreement, I acknowledge that the information/suggestions should only be implemented or acted upon in consultation with, and the explicit approval of my personal mental health professional if I have one.
2) I acknowledge and understand that Dr. Osborn’s role as a consultant or coach is not to diagnose and/or to cure a medical condition, but to help me improve the quality of my life and to help establish goals and objectives for change.
3) I acknowledge that the information/suggestions offered by Dr. Osborn may not ultimately be appropriate for my particular needs. Dr. Osborn does not warrant a cure for any medical condition/disease/disorder or that my life will ultimately improve.
4) Dr. Osborn will set up a consultation schedule with me, however, Dr. Osborn will be unavailable at any time other than during scheduled appointments. Dr. Osborn reserves the right to terminate this agreement and/or relationship at any time.
5) Even though Dr. Osborn is a licensed physician in the Commonwealth of Pennsylvania, I acknowledge and understand that Dr. Osborn is not my personal physician and that a patient-physician relationship is not created between myself and Dr. Osborn regardless of our interactions. Furthermore, I acknowledge and understand that information I provide to Dr. Osborn does not have the same legal protection as the information I give to my personal physician. I understand that information I provide to Dr. Osborn is not covered by HIPAA or any other federal, state or local laws.
(please print name, sign, and date)