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Consent Form

Last updated: 8 June 2026

1. The Nature of Lifestyle Medicine

Lifestyle medicine is an evidence-based medical approach focused on the prevention, management, and, where possible, reversal of chronic disease through therapeutic lifestyle interventions.

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Lifestyle medicine interventions may include guidance relating to:

  • Nutrition and dietary patterns

  • Physical activity and exercise

  • Sleep health

  • Stress management

  • Mental and emotional well-being

  • Substance use reduction

  • Social connection and behavior change

  • Weight management and metabolic health

  • Cardiovascular and longevity-focused risk reduction

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I understand that:

  • Recommendations are based on current scientific evidence and clinical judgement.

  • Individual results vary and often depend on the degree of lifestyle changes made, but outcomes cannot be guaranteed.

  • Lifestyle interventions complement, but do not replace, appropriate medication.

2. The Nature of Telehealth

Consultations may be conducted either in-person or via telehealth (over a video platform, such as Zoom).

 

I understand that:

  • Telehealth may have limitations compared with in-person consultations, including the inability to perform a full physical examination. Every reasonable effort will be made to ensure secure and reliable communication systems.

  • Technical difficulties may occasionally interrupt consultations.

  • Certain conditions may require in-person assessment, and my practitioner may recommend an in-person consultation if clinically appropriate.

  • Reasonable measures will be taken to protect the privacy and confidentiality of my health information in accordance with South African law and HPCSA ethical guidelines.

  • It is my responsibility to ensure I am in a private area with an internet connection and an appropriate device for a telehealth consultation.

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Telehealth services are not appropriate for medical emergencies. If you experience a medical emergency, you should immediately contact emergency services or seek care at the nearest emergency facility. 

3. Privacy, Confidentiality, and Data Protection

Your health information will be handled in accordance with applicable South African laws, including:

  • Protection of Personal Information Act (POPIA)

  • Health Professions Council of South Africa (HPCSA) ethical guidelines

Electronic communications and medical records will be stored using secure systems where possible. However, no electronic system can be guaranteed to be completely secure.

You should also take reasonable steps to protect your own privacy during telehealth consultations (e.g., being in a private location).

4. Use of Artificial Intelligence (AI) in Healthcare

This practice may use artificial intelligence (AI) technologies to support aspects of care. These tools may assist with:

  • Generating consultation notes or summaries

  • Transcribing consultations

  • Assisting with report preparation

 

​AI tools are used in accordance with ethical principles that require protection of patient privacy, confidentiality, and fairness in healthcare delivery. AI systems are used only as support tools and do not replace professional clinical judgment. The practitioner remains fully responsible for all medical decisions and recommendations.​

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You have the right to decline the use of AI in your care where feasible, without affecting your access to treatment.

5. Consent to Treatment

By signing this document, you acknowledge that:

  • I understand the nature and purpose of lifestyle medicine services.

  • I understand the benefits and limitations of telehealth consultations.

  • I understand that outcomes cannot be guaranteed.

  • I have had the opportunity to ask questions and receive satisfactory answers.

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