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Secured File Opening Formality

Client File - LoveRadiance
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Client File - Admission Form

LoveRadiance - Naturopathy

1. Consultation Prerequisites

📋 Confidential Document - To be completed by the client before the first consultation

The client hereby attests:

  1. that he/she has come of his/her own free will to request the services of the naturopath and has not been subjected to any pressure on his/her part;
  2. that he/she has presented himself/herself under his/her real name, in good faith and for no other purpose than the genuine purpose of naturopathic care;
  3. that he/she has provided information relating to his/her personal file. In accordance with the provisions relating to the Personal Information Protection and Electronic Documents Act (PIPEDA), and unless we receive contrary notice from you, we consider that you thus consent to our recording in a file all the information you have transmitted or will transmit to us, verbally or in writing. Also, unless we receive contrary notice from you by registered letter, we consider that your consent will be valid for a period of five (5) years;
  4. that he/she cannot ask the naturopath to perform a medical act or diagnosis reserved for practitioners of allopathic medicine or others within the meaning of the professional code, nor can he/she incite him/her to do so;
  5. that at no time has the naturopath suggested that he/she cease his/her allopathic medication;
  6. that he/she is himself/herself responsible for the medical vocabulary he/she uses and that he/she cannot in any way attribute responsibility for it to the naturopath, even if the latter must use these terms for explanatory purposes;
  7. that any receipt issued by the therapist to the client is issued strictly to acknowledge receipt by the therapist of the payment made by the client for services rendered. The use of this receipt by the client for any purpose whatsoever including, without limitation, obtaining a refund of such payment by any person, including an insurance company, shall remain the entire and exclusive responsibility of the client, the therapist making no representation as to the admissibility or inadmissibility of the service received for such purpose.

The client, by his/her signature, attests to having taken note of the statements in the aforementioned articles and not being in default with regard to their content.

Opening Formalities - File Creation

2. Personal Information and Health Questionnaire

✨ Information from page 1 has been automatically copied here!

Personal Information

Measurements

Purpose of Consultation

3. Hereditary Factors and Treatments

Hereditary Factors

Main family diseases

Treatments

4. Dietary Information and Health

Dietary Information

Additional Health Information

Blood Pressure

5. Body Functions

Circulatory Function

Hepatic Function

Intestinal Function

Nervous System

Renal Function

Stomach Function

Ovarian Function

Thyroid Function

6. Mutual Commitment

Rescheduled or Canceled Appointment

The implementation of the requested service begins several days in advance and ongoing preparation is necessary and must be carried out for the type of service you reserve. This service also includes a physical or virtual meeting time, i.e., "the appointment." The service that is requested and reserved therefore begins well before the date and time scheduled for the meeting. This is why a cancellation and rescheduling policy is necessary and thus provided for, since the service is indivisible and becomes payable in full as soon as it begins to be offered, i.e., more than 72 hours before the scheduled meeting time.

Therefore, out of respect for the mutual commitment to honor the appointment time as well as the service requested and rendered, should an appointment need to be rescheduled or canceled, it is essential to notify by phone at (514) 990-2699 (no text messages, it's a landline) at least 72 business hours before the scheduled date and time.

(Sundays are holidays, so add 24 additional hours for Monday appointments).

If the minimum 72-hour deadline is not respected, the client agrees to pay in full the cost of the service requested and received, within 48 hours following the date and time of the canceled or rescheduled appointment. If this deadline is exceeded, administrative management fees may apply in addition.

If you cannot come to the office appointment or cancel within the specified timeframe, for any reason whatsoever, including Covid, your appointment will be held by teleconsultation, either by phone, Teams or Messenger, Zoom, etc., depending on possibilities.

Delay at an Appointment

In the event of a delay of more than 10 minutes, without having notified of the delay by phone at 514-990-2699 (no text messages, it's a landline), it is at the consultant's discretion to wait for the client or leave the office. Service fees will also be requested in full if applicable.

N.B. These terms are subject to change without notice, as are the costs associated with various services, training courses, and workshops. The latest version displayed on the LoveRadiance website is the one to which a client consents by default, either by requesting a service or registering for a workshop or training course.

Signatures - Mutual Commitment

Both parties mutually commit to respecting the terms of this document

The Practitioner

Signature Pascal N. Paquette

Pascal N. Paquette

The Client

LoveRadiance

© 2025 LoveRadiance - All rights reserved

For any questions: info@loveradiance.com | (514) 990-2699

Privacy and Bill 25

By using this site, you implicitly consent to the collection of non-identifiable statistical data.

By subscribing to the mailing list, using the paid site or the commercial functions of this site, you implicitly consent to the storage and use of your transmitted contact information by the relevant third parties and by this website. The data you provide will be stored in MailChimp, which already has all the necessary means to allow you to consult your personal data, to modify them and to remove yourself from email messages. Furthermore, upon manual request, your details can be deleted within a reasonable period of time.

The only person with access to this data is Pascal N. Paquette and he is the person in charge with whom you must communicate for any information concerning your personal data.

As long as you are an active or inactive client, you agree that your contact information may be kept and used for communication purposes. If in the future you wish to stop receiving mailings, please unsubscribe from the mailing list via MailChimp, or by requesting it. Until you unsubscribe or request to do so, I will assume that you wish to keep receiving occasional communications and that you authorize me to communicate with you in various ways.

File opening formality

Fleur de Vie - PARLECOEUR

Alternative to online Document

  • File opening
  • Health report
  • Mutual agreement

Please complete and sign the document and bring it with you to your first appointment. You can also send it by email before your first appointment to info@loveradiance.com. You can fill in the document on your computer, save it and send it by email. Your email will stand up for your signature.

Steps to complete and submit the form:
-Download the form to your computer
-Save the form to your computer
-Open it after saving it
-Complete all interactive fields
-Save
-Attach to an email

(It is also possible to complete these steps on a tablet or phone, however, it will be easier on a computer. Alternatively, you can print, fill it out by hand, and scan or take high-quality photos, then send it.)

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Pascal Paquette

Le bureau est ouvert de 5h00 à 15h00, heures du Québec. Congé le dimanche.

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