INFORMED CONSENT - GENERAL AND MEDICAL RELEASE
Guests, students, seva, and staff participating at the Tree of Life are subject to the following general and medical policies:
I understand that by registering in any Tree of Life activity I automatically become a member of the Tree of Life Foundation and the Tree of Life Center US and a spiritual student of the Cousens’ School of Holistic Wellness. As such I agree to uphold the TOL Dharma* and Student Guidelines*. This includes refraining from behaviors such as the use of drugs, alcohol, tobacco, inappropriate nudity, sexual or any other sort of harassment of others, gossip, slander, negativity, or any other behavior that undermines or interferes with the awakening and healing process of others. This also includes not following mandatory medical protocols for those fasting, including not attending mandatory morning check-ins for all fasting programs. I understand the Tree of Life holds the right to ask me to leave without refund if I choose not to follow these simple guidelines.
If significant health issus are not disclosed on the Health Intake Form or disclosed to the medical staff or doctor prior to arrival, the Tree of Life Center US reserves the right to ask a guest to leave without a refund.
I am aware that participating in any activity on the Tree of Life property carries some risk, including but not limited to the risks listed below. I choose to participate in any TOL activity with awareness of these potentials, and I agree to be responsible for my own safety.
Nature & Land: There may be risks of dehydration, sunburn, and possible injury due to the nature of the land and wildlife in the surrounding area. I am also aware that there is risk involved when participating in an Inipi (sweat lodge)* due to the intensity of the energy present.
TOL Farmland: There may be risks of injury if I choose to serve on the TOL farmland or attend farm classes; which may involve the use of sharp objects, motorized and heavy equipment/vehicles.
Spa - Services: There may be a small risk involved in any cellular detoxification service, including but not limited to: Lymphatic Massage, General Body Work, Energy Work, Ozone Steam Box, Infrared Sauna, and chlorine-free Hot Tubs.
Spa - Pool: there is no lifeguard on duty at the Tree of Life swimming pool. I agree to be responsible for my own safety while using the pool and surrounding premises.
TOL Café kitchen: There may be risks of injury if I choose to attend food preparation classes with the use of sharp objects and heavy equipment.
Therapeutic Procedures: There may be risks involved in any therapeutic procedure offered at the Tree of Life including but not limited to: Nutritional and Medicinal Supplementation, Fasting, Auricular Acupuncture, Vitamin and Mineral Shots, Homeopathic Vaccinations, Scar Injections, Liver Gall Bladder Flushes, and Cellular Detoxification Bodywork Treatments. I also understand the risks involved in this process and agree to the testing, counseling, and other therapeutic procedures.*
I also understand that there are various detoxification modalities such as saunas, yoga and taking daily enemas that are recommended, and that instructions and support will be given. Because the Tree of Life Center US is educational in nature, I understand that they are not set up to attend to the seriously ill.
The Tree of Life, under Gabriel Cousens, MD, MD(H), has developed a cutting edge diabetes program for Type 1 and for Type 2 diabetics. Any program of this nature has a certain risk associated with it, including diabetic ketoacidosis for Type 1 diabetics, which may require hospitalization, or allergic reactions to prescribed supplements. I understand these risks and agree to participate in the program regardless of the risks.
I understand that in the event that emergency care is required and to be administered by the Tree of Life medical staff, I will be billed for these additional medical services. These additional medical services may include, but are not limited to, intravenous therapies and after-hours monitoring. Fees for these services are to be paid at time of service. I understand that I have the option to refuse these services, in which case I will be required to go to the hospital. It is the Tree of Life's preference to attend to these special needs on Tree of Life property; however, in some cases, such as Type 1 diabetic ketoacidosis, I understand that hospital care will be my only option. The Tree of Life medical team will arrange for transportation to the hospital should such an event occur.
I fully understand that I am responsible for following the guidelines of my healing plan. I understand that if I choose not to follow the plan, I cannot expect results. I agree to the medical policy found on the website (www.drcousens.com) and in the attached information.
I understand I may receive a doctor prescribed supplement program following my evaluation, which will be tailored to my individual needs. I am aware that purchasing these supplements is optional, but strongly recommended for my health and may cost an additional $1000 or more depending on my needs. I am also aware that these supplemental needs may shift as my body is brought back into a balanced state.
I understand that the physician may require additional time with me—up to four hours—depending on my individual health. I understand I am charged for the amount of time I am with the physician, and may inform the physician at the beginning of my
consultation what my budget allows for. A standard appointment is 2.5 hours. If an appointment runs for 3 hours, I will be charged for 3 hours.
I have read and understand the Tree of Life Center US’ Notice Regarding Privacy of Personal Health Information located on our website (www.drcousens.com) and at the Oasis front desk.
I understand to respect the integrity of both the inward journey of our healing guests and the Tree of Life. Personal healing offered by anyone other than approved staff members (massage, deep energy work, and bodywork) is not permitted on Tree of Life Property. Please make use of our spa facilities with approved facilitators.
I agree to allow photos & videos taken of me to be used for marketing purposes. Photos & Videos may be placed in Tree of Life publications, websites, Facebook, Twitter, Tree of Life and affiliated blogs, or with organizations whom the Tree of Life might contract for educational and marketing purposes.
I am aware of and understand the rates and fees that apply to the services and treatments I may choose to partake in during my stay at the Tree of Life Center US, which are outlined in the Important Policies document*.
I understand payment for any products or services will be collected or charged to my credit card as follows:
• Services related to accommodation/programs/workshops: at time of booking
• Products in the store or dispensary: at time of purchase
• Medical services: at time of service
• Spa services: by check-out
I understand that any services or products that I purchase, that are not charged at the time when due (see above), will be charged at a later date.
I agree to give 30 days notice of cancellation for appointments with Dr. Cousens and all Tree of Life Programs, 48-hour for other medical services, 24-hour for spa services. If I cancel without proper notice, or if I am 15 minutes late or more, I will be charged in full for the scheduled services. I understand and accept the Tree of Life Cancellation Policy.*
REFUND POLICY: Cancellations are refunded in full, less a $100 processing fee, with notice more than 30 days prior to your checkin day. Cancellations, including a shortening of stay, made within the 30-days prior to check-in are not refundable nor are the funds transferable. Room, schedule, and program changes are subject to a $50 processing/housekeeping charge, per change.
INSURANCE POLICY: Upon your request, we will provide the appropriate invoice for submitting to your insurance company. We do not bill insurance companies directly. Although Dr. Cousens is an M.D., he is also licensed in the state of Arizona as a Homeopathic Physician. Medicare does not reimburse clients for services rendered by any homeopathic physician. Other insurance companies usually do reimburse in part or in full. We urge you to please check with your insurance company before your appointment with the doctor. For billing questions, please call our office.
I hereby agree to indemnify and hold harmless the Tree of Life Center US and the Tree of Life Foundation, its agents, officers, and employees from all claims or demands of any sort which arise out of or are caused by my participation while at the Tree of Life Center property in Patagonia Arizona, or at any other location where an event is being held that is sponsored by the Tree of Life Center US.
I waive and release the above mentioned from all liabilities, claims or demands of any sort that I may have for personal injuries or for injuries to property arising out of my participation at the Tree of Life Center US. I also hereby consent to, permit, and agree to pay for emergency treatment in the event of illness or injury while at the Tree of Life Center US.