DEED OF ACKNOWLEDGMENT INFORMED CONSENT AND INDEMNITY
DATED AT MELBOURNE THIS DAY OF 2000
AND: OncoCare International Pty. Ltd. trading as the OncoCare Clinic, David G.
Spall and Malcolm A. Traill (which together with their agents and assigns, shall be collectively referred to as "the Practitioner").
1. I acknowledge that I have been informed by the practitioner and clearly understand that:-
Whole Body Hyperthermia, Microwave (R.F.) Therapy, Bio Modulation,
Bio Immunotherapy, Bio Electric Therapy (Galvano) and any other therapy will
be administered only with my consent and by my request after careful
consideration following the practitioner's recommendation.
1.2 Other modes of therapy for cancer are available such as:-
Surgical Open surgery and excision
Mechanical Stents etc
Radiation X-ray therapy, radium therapy etc.
Pharmocologic Chemotherapy and phyto-pharmaceuticals
No Intervention Watchful waiting and palliative care
I understand that
this treatment regime for cancer is NOT held out as a cure and
that in the opinion of the majority of mainstream medicine, particularly
oncologists in Australia, this therapy is regarded as being of little or even no
value in the treatment of my cancer.
understand that OncoCare International Pty. Ltd. trading as the OncoCare
Clinic has made available treatment options which they believe may be of help
to me in my condition.
treatment will be performed by a duly trained operator under the
supervision of the practitioners.
understand that I may experience some mild side effects such as discomfort
during treatment and immediately after treatment, including sensations of heat
and possible weakness. Some sensitive individuals may describe the side effects
as intolerable and I may communicate with the operator who may make
appropriate adjustments to make me more comfortable.
1 .7 Some symptoms relating to my illness may become temporarily worse for the first few days or weeks after treatment and that the full benefit of the treatment may not be realised until several months after the treatment.
1.8 This treatment is a NON COVERED TREATMENT as it is currently not considered reasonable and necessary by the Health Insurance Commission under the Medicare program and/or other private medical insurance schemes. I have been clearly informed and understand that neither Medicare nor other insurance coverage will pay for the treatment in whole or in part and that I will be personally responsible for payment for the treatment to OncoCare International Pty. Ltd. trading as the OncoCare Clinic. Unless otherwise agreed I will pay for the treatment at the time it is rendered to me.
2. I indemnify and release the practitioner as follows:-
read all the provisions of this Deed and have had the treatment clearly
explained to me by my practitioner so that I fully understand what I am signing
and the nature of the treatment.
2.2 I hereby request and consent to receive this treatment.
hereby release and indemnify the practitioner and OncoCare International Pty.
Ltd. trading as the OncoCare Clinic from all actions, suits and demands for
damages and/or any liability in respect of damages in relation to the treatment
or arising directly or indirectly out of treatment.
acknowledge that the practitioner may plead this release as a bar absolute to
any and all actions, suits and demands made by me arising directly or indirectly
out of the treatment.
In Witness whereof the parties hereto have hereunto set their hands and seals the day and year first hereinbefore written.
SIGNED, SEALED AND DELIVERED BY (the patient)
THE PRESENCE OF
SIGNED, SEALED AND DELIVERED
FOR AND ON BEHALF OF THE ONCOCARE CLINIC
IN THE PRESENCE OF (witness)
INFORMED CONSENT, UNDERSTANDING AND
In presenting for treatment options offered by OncoCare International Pty. Ltd. trading as the OncoCare Clinic you have been asked to review carefully all the other choices of treatment available, in particular, the time honoured conventional cancer treatments, namely, surgery, chemotherapy and radiotherapy.
You are encouraged to ask questions not only of the practitioners at this Clinic, but also of your surgeon, radiotherapist and oncologist concerning the effectiveness of the treatment offered, as well as the side effects, both immediately after treatment, and in the long term, as to your quality of life.
It is important, that you understand that the treatment offered at this Clinic is not in opposition to conventional cancer therapy (chemotherapy and x-ray therapy), but is offered as complementary and adjunctive.
It is therefore your responsibility to make an informed choice, based on your understanding from the information given to you.
I have read, and understand, the contents of this document, that it is entirely my decision, and have not been coerced into accepting or declining the treatment available to me.
Date / /200
Copyright OncoCare International Pty Ltd 2001