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LoveRadiance logo - Soul Coaching and naturopathy by Pascal N. Paquette
LoveRadiance
Admission form

Secure file opening

To be completed a week before your first appointment.

This form lets us come to your first session prepared. The fuller it is, the more of our time together goes to you, rather than to gathering information.

Go to the form Read the mutual agreement
Pascal N. Paquette, psychosociologist, Spiritual Life Coach and naturopath
One week
before the appointment
Six sections
to fill in at one sitting
Confidential
Pascal alone has access
Once only
when the file is opened
Confidentiality

Your answers belong to you

Your answers serve your own guidance and nothing else. Pascal N. Paquette is the only person with access to them, and the only one to write to with any question about your data.

The form

Your admission file

Six sections, from the prior attestation to the signatures.

LoveRadiance Logo

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 1-514-990-2699 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 online, either by phone, Teams, Messenger, Google Meet, FaceTime or Zoom, depending on what is possible.

Delay at an Appointment

In the event of a delay of more than 10 minutes, without having notified of the delay by phone at 1-514-990-2699, 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

Enter your full name if the form is filled in on a computer
LoveRadiance

© LoveRadiance - All rights reserved

For any questions: info@loveradiance.com | 1-514-990-2699

After you send it

What happens next

Your file reaches us directly. There is nothing else to do but come to your appointment.

Good to know

The other documents

Mutual agreement

Rescheduling, cancellation, lateness and terms of use. The form points to it in its sixth section. Read the agreement

Online sessions

If you cannot travel, the session is held online rather than cancelled. See how

Your information

Protection of personal information and Law 25

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

By signing up to the mailing list, or by using the paid or commercial functions of this site, you implicitly consent to your details being kept and used by the third parties concerned and by this website. Among other things, your details will be held in the mailing list, which already provides every means for you to view your personal data, amend it and withdraw from email sends. Furthermore, on request, your details can be deleted within a reasonable time.

The only person with access to this data is Pascal N. Paquette, and he is the responsible party to contact for any information concerning your personal data.

For as long as you are a client, active or inactive, you consent to your details being kept and used for the purpose of communication. If in future you no longer wish to receive sends, please unsubscribe from the email list, or ask to be removed. Until you have unsubscribed or made that request, I will take it that you wish to keep receiving occasional communications and that you authorise me to contact you by various means.

Privacy policy Cookies policy
Another way to do it

If you prefer paper

If you would rather download the document than fill it in online, you can complete and sign the form below and send it by email at least a week before your first appointment, to info@loveradiance.com.

Download the form The downloadable form is available in French. To complete it in English, please use the online form above.

  1. Download the form to your computer.
  2. Save the form on your computer.
  3. Open it once it is saved.
  4. Fill in every interactive field.
  5. Save it.
  6. Attach it to an email.

You can also print it and fill it in by hand, then scan it or take clear photographs, and send those.

Do you have a question?

Write to us

Or call 1-514-990-2699, at any time.

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