CONSENT TO RETREAT MICRODOSE SERVICES
This is an informed consent document that has been prepared to help inform you about Retreat Microdose’s model of information, education and coaching, the associated risks, as well as alternatives. It is important that you read this information carefully and completely.
1. SERVICES: I understand that that Retreat is strictly a provider of information, education, and coaching services that are intended to allow me to make my own decisions related to microdosing. I understand and am informed that Retreat is not a licensed provider of medical or other healthcare services and is not intended to replace appropriate medical care. Even in the event that information received happens to be from physicians or other licensed health professionals, I further understand that any consultations, evaluations, recommendations, and discussions are strictly to allow me to make my own decisions and not the practice of medicine or any other health profession. I accept sole and exclusive responsibility for my own decisions and use of information from Retreat.
I understand that I am expected to consult my own primary care provider and other health professionals for my specific medical needs, and to seek emergency and urgent care if needed. I understand that Retreat makes no representations, claims or guarantees that my medical problems or conditions will be cured, solved, or helped by any recommendations, content, coaching, education or information I receive from Retreat.
2. NO GUARANTEE: I have been informed that the materials and services made available to me are not intended to diagnose or treat disease, and instead are intended merely as a guide for me to utilize in developing an appropriate overall health-supportive program for myself and to monitor progress in achieving my own goals. Results are not guaranteed and there is no promise of any cure. Accordingly, I understand that payment(s) for services are not conditional on my decisions to utilize any information or recommendation or my response to care.
3. RISKS: I understand that, even as state law in certain states has taken a more liberal view, psychedelics are currently illegal under United States law and categorized as Schedule I controlled substances, making it a federal crime to purchase, possess, transport, ingest, or otherwise interact with them. I understand that I am personally responsible for any decisions related to handling of psychedelics, which may violate federal and state law, and that Retreat is not responsible in any way for my decisions or actions. I understand that certain substances may be toxic in excessive doses. I agree to inform my health practitioner (separate from Retreat) if I experience gastrointestinal upset (nausea, gas, stomachache, vomiting), allergic reactions (hives, rashes, itching, tingling of the tongue, headache), or any unanticipated or unpleasant effects, and I agree to seek emergency care and dial 9-1-1 if needed.
4. PREGNANCY: I understand that some psychedelic materials may be inappropriate during pregnancy, and I will notify my independent health practitioner if I am or become pregnant.
5. ALTERNATIVES: I understand that the alternatives to accessing content and acting based on education, information, coaching or recommendations contained therein include doing nothing, making lifestyle changes, and/or seeking medical or other care from providers who take a different, more traditional or conventional approach. I acknowledge that Retreat’s focus on microdosing is distinctive and unusual, and that many alternative options are available for my consideration.
6. QUESTIONS AND ANSWERS: It is my personal responsibility to ensure that I understand the services provided and the related risks. I understand I should not enter into any agreement until all of my questions have been answered to my satisfaction or if I do not understand anything presented to me.