Naturopathic Medicine Informed Consent & Scope Disclosure

# Naturopathic Medicine Informed Consent & Scope Disclosure **Practice:** ___________ **Naturopathic Doctor (ND):** ___________, ND, license number ___________, State of ___________ **Patient Name:** ___________ **Date of Birth:** ___________ **Date of Consent:** ___________ --- ## 1. What Is Naturopathic Medicine? Naturopathic medicine is a distinct system of primary care that combines modern scientific knowledge with natural therapies. Licensed Naturopathic Doctors (NDs) in states with licensure laws complete accredited four-year doctoral programs and pass national board examinations. NDs in licensed states may diagnose disease, order laboratory tests, prescribe certain medications, and perform minor office procedures within their defined scope of practice. **Important:** The scope of practice for NDs varies significantly by state. In unlicensed states, the services described below may not include medical diagnosis or prescription authority. The Patient acknowledges that they have been informed of the ND's specific legal scope in ___________, described as follows: ___________. --- ## 2. Services Potentially Included in Naturopathic Care Depending on the ND's scope in this jurisdiction, services may include: - Comprehensive health history, physical examination, and laboratory evaluation - Nutritional assessment and therapeutic nutrition - Botanical (herbal) medicine - Homeopathy - Physical medicine (manipulation, hydrotherapy, soft tissue work) - Lifestyle and behavioral counseling - Acupuncture (where separately licensed or within ND scope) - Minor surgery (where within scope) - Prescribing pharmaceuticals, bioidentical hormones, or compounded preparations (where within scope) - Ordering and interpreting diagnostic laboratory tests and imaging referrals Services the ND will provide in this case: ___________. ---