Consent Form
Priority Solutions HPV 12 Week Program
Please open and read each of the following statements and terms before acknowledging acceptance at bottom of the page.
Each of the respective professionals at Donielle Wilson, N.D., Inc. d/b/a Dr. Doni (“Dr. Doni” and its professionals “the Dr. Doni Professionals”) is a Naturopathic Doctor who has been awarded a doctorate in Naturopathic Medicine and has completed their residency in Naturopathic Medicine. Optionally each of the respective Dr. Doni Professionals may have a certificate in Midwifery, and may have completed internships in both midwifery and women’s health.
Each of the respective Dr. Doni Professionals is licensed as a Naturopathic Physician in Connecticut, Arizona, California, and/or Washington states, or all of the above. Optionally, each of the respective Dr. Doni Professionals may also be certified as a midwife by the North American Registry of Midwives (NARM) and the Certification Board for Nutrition Specialists.
Each of the respective Dr. Doni Professionals is NOT a medical doctor. They are NOT licensed as a midwife and do not provide prenatal care and do NOT care for patients during labor.
In New York (and any other locations where a license is not offered), each of the respective Dr. Doni Professionals provides their services as a consultant because New York State does not license the profession of naturopathic medicine.
We are a private member association. Services may include dietary and lifestyle recommendations, suggestions regarding the use of natural therapies, and support with wellness care.
Dr. Doni’s method of healing requires each of the Dr. Doni Professionals to look at the body as an intricate, whole system; a problem with one part of your body will be considered within the context of your entire being. When coming up with a plan for improvement of health, each of the respective Dr. Doni Professionals will focus on any or all of the following: your digestive health and diet, your sleep patterns, your neurological health, mood, amount of stress, and your menstrual cycle. Each of the respective Dr. Doni Professionals will help to restore these areas of health through natural therapies to establish healthier balances within the body.
A consultation with each of the respective Dr. Doni Professionals does not create a doctor-patient relationship.
You also agree not to rely on information provided by any of the respective Dr. Doni Professionals as a substitute for, nor a replacement of, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Do not disregard, avoid or delay obtaining medical or health-related advice from your healthcare professional because of your interaction with any of each of the respective Dr. Doni Professionals. The use of any information provided by any of each of the respective Dr. Doni Professionals is solely at your own risk.
Nothing stated or made available through any services provided by any of each of the respective Dr. Doni Professionals are intended to be, and must not be taken to be, the practice of medicine or the provision of health care treatment, instructions, diagnosis, prognosis, or advice.
You understand that suggestions provided may be considered “experimental” and not standard of care. When those services are provided, you agree that you are accepting responsibility for your health and any risk associated.
You consent to taking responsibility for following any recommendations provided.
There are no guarantees of improvement in your health. The best outcomes occur with consistent follow-up appointments, when we work together to create your plan, and when you take responsibility for your health and healing.
In the interest of your safety and effective care, all case updates are handled through phone or office appointments only (not email or non-appointment calls). There are no exceptions to this policy.
You may text or email with simple questions. More complex questions and follow-up on recommendations require a paid appointment.
If you experience any unexpected or negative symptoms you understand to discontinue any supplements and/or recommendations and to contact your doctor and Dr. Doni for an appointment or, if an emergency, to seek emergency care.
We are not able to refund fees for consultations, packages of consultations, tests, or services.
If over 2 years have passed since your last appointment with any of each of the respective Dr. Doni Professionals, we may require that you complete an initial appointment again or pay a “reactivation” fee.
Continued refills on products may require follow-up appointments and tests before being refilled.
If you ever have any concerns regarding our work together, you agree to contact Dr. Doni to discuss those concerns so that we can resolve any miscommunications together. Any disputes will be handled by arbitration with the American Arbitration Association in New York.