Dr. Carter Disclosures

I hereby request Functional Medicine treatment and therapies, including nutritional consultations, diagnostic procedures including laboratory testing, and various modes of nutritional therapy by Dr. Michael Carter MD. 

I understand and am informed that in the practice of Functional Medicine, some therapies and modalities of treatment are considered “investigational”, “experimental”, or “alternative” by the conventional medical community and that there are some risks to treatment. I also understand that most insurance companies do not cover these procedures that include but are not limited to:

Nutritional Counseling

Nutritional Supplements

Peptide Therapy

Additional therapies that can be done at home or other recommended facilities

Functional Medicine Testing including but not limited to:

Salivary or other Hormone Testing

Nutritional Status Testing

Gastrointestinal Function Testing

Heavy Metal Testing

Genetic Testing

Dr. Carter does not treat cancer. He only provides root cause diagnosis of conditions that may contribute to cancer and helps patients understand how those root causes play a role in cancer. He will recommend protocols to address root causes.

I do not expect the Doctor to be able to anticipate and explain all the risks and complications, and I wish to rely on the Doctor to exercise judgment during the course of the consultation and recommendations which the Doctor feels at the time, based upon the facts then known, is in my best interest. Prescriptions will only be written after an initial telemedicine consultation. 

I agree that I am accepting or rejecting this care on my own free will and choice. I am not an agent of any private, local, county, state or federal agency attempting to gather information without so stating my intentions.

I have read and/or have had read to me, the above consent. I have also had an opportunity to ask questions about its content, and by signing below, I understand the above. I intend this consent form to cover the entire course of my treatment for my present condition and for any future conditions for which I seek treatment.