POLICY
Consent statement
Version 1.0 – Date: November 1, 2024
At BMI Clinic, we believe it is important that you are fully informed about the treatments you undergo with us. This Consent Statement (Informed Consent) provides an overview of the proposed treatment(s), potential risks, benefits, and alternatives, so that you can make an informed decision.
By providing digital consent in the app, you confirm that you have received all relevant information and agree to the proposed treatment(s). We encourage you to ask any questions and discuss any concerns with your healthcare provider to ensure you are fully informed about the details of the treatment.
This statement is provided to safeguard your rights and to ensure that we have your consent to begin the treatment.
Do you have any questions regarding this Consent Declaration? Please feel free to contact us for further clarification; we are here to assist you.
1. Information on side effects of weight loss medication
I acknowledge that weight loss medication may cause side effects ranging from mild to severe, depending on my individual response. I understand that I am responsible for monitoring my health while using this medication and that it is important to report any changes in my health to my healthcare provider. I indemnify BMI Clinic from liability for any consequences, unless there is negligence on the part of the clinic.
2. Communication with my general practitioner
I understand that it is my responsibility to inform my general practitioner about the treatment at BMI Clinic. I will share my treatment information in a timely manner to ensure the continuity and safety of my care. Any negligence in fulfilling this obligation is my sole responsibility.
3. Prevention of dehydration
I am aware of the risk of dehydration associated with the use of weight loss medication, particularly due to potential gastrointestinal issues. I will ensure adequate hydration and take the recommended preventive measures to avoid dehydration.
4. Impact on personal experience and mental health
Weight loss medication may affect my mental well-being, such as mood swings or other emotional effects. I am responsible for monitoring my mental health and will discuss any changes with my healthcare provider. BMI Clinic is not liable for negative mental health effects, unless there is negligence on the part of the clinic.
5. Safe purchase of medication
I declare that I will obtain my weight loss medication solely through BMI Clinic or suppliers authorized by BMI Clinic. Purchasing medication from unofficial sources may harm my health and is entirely my own responsibility, and I cannot hold BMI Clinic liable in any way for such actions.
6. Access to client records by doctors within BMI Clinic
I hereby authorize BMI Clinic to grant access to my medical records to physicians under strictly defined circumstances, even if they do not have a direct treatment relationship with me. This access will be conducted in compliance with Dutch privacy laws, including the General Data Protection Regulation (GDPR) and the Medical Treatment Agreement Act (WGBO). Each instance of access to my records will be documented and must adhere to privacy requirements. BMI Clinic ensures full traceability of all access to my data.
7. Exchange of relevant medical information
I consent to the sharing of my medical information with my general practitioner and other relevant healthcare providers, if necessary for my treatment. This data exchange will occur in compliance with the GDPR. I may withdraw my consent at any time by notifying BMI Clinic.
8. Client rights under the GDPR
I have the right to access, correct, or request the deletion of my data. I also have the right to object to the processing of my data and the right to data portability. More information on this can be found in the Privacy Policy.
9. Withdrawal of Consent
I understand that I may withdraw my consent at any time by contacting BMI Clinic at privacy@bmi-clinic.com. Withdrawal of my consent does not affect the lawfulness of the processing of my data prior to the withdrawal.
10. Self-injection and risks
I understand that the weight loss treatment at BMI Clinic involves self-administering injections to promote weight loss. I have been informed about the benefits, mechanism of action, and potential risks of the treatment, including side effects such as irritation at the injection site, nausea, and headaches, as well as potential unknown long-term effects.
11. Risks and Benefits
I am aware of the risks associated with the weight loss treatment at BMI Clinic and understand that not all risks may be known in advance. I have had the opportunity to ask questions and feel adequately informed. By signing this statement, I waive any right to compensation or claims against BMI Clinic for any consequences arising from the treatment, except where the clinic acts in violation of its legal duty of care.
12. Use of telemedicine and digital care
I consent to the use of digital care platforms and telemedicine technologies, as provided by BMI Clinic, for the treatment and monitoring of my health. This will be done in accordance with applicable laws and regulations, allowing me to be remotely guided by my healthcare providers.
13. Right to a second opinion
I have the right, at any time during my treatment at BMI Clinic, to request a second opinion from another qualified healthcare provider.
14. Right to refuse treatment
I understand that I have the right to refuse the proposed treatment or discontinue it at any time, without losing my right to further care and treatment. I acknowledge that my decision to refuse or discontinue treatment will not affect my future access to medical care at BMI Clinic.
15. Obligation to provide information
16. Review of consent statement
I understand that this consent form may be periodically reviewed to comply with changing legislation or medical guidelines. BMI Clinic shall notify me of any pertinent changes, and I retain the right to reconsider or withdraw my consent.
17. Annual reconfirmation of consent
I understand that I am required to reconfirm my consent annually or in the event of significant changes to my treatment.
Confirmation of Consent
By agreeing, I confirm that I have read, understood, and voluntarily consent to the treatment at BMI Clinic. I take responsibility for my health and am aware of the need to inform my general practitioner and to monitor my mental and physical health during the treatment. I acknowledge that I will obtain my medication exclusively from authorized suppliers and consent to the processing of my medical data as outlined in this statement. The information provided is accurate and truthful, and I release BMI Clinic from liability for unforeseen consequences, provided the clinic fulfills its duty of care and complies with its legal obligations.
Contact information
For any questions or concerns regarding this consent declaration, you may send an email to privacy@bmi-clinic.com.
For any questions or concerns about my treatment, I can contact the medical team at BMI Clinic or send an email to support@bmi-clinic.com.
