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THE WAY WE WORK!
We request you to do two things:
1. You need to bring along all your medical reports and give us copies of them. In addition you need to fill in THE FIRST VISIT FORM.
2. We require you to sign a Disclaimer & Release of Liability Form. You need to agree to release us from any liability and responsibility in the event that problems or complications arise from the consumption of our herbs.
Based on the feedback you give in the First Visit Form and Medical Reports we shall prescribe the necessary herbs. It is therefore very important that you answer the questions asked adequately – give all possible details of your problems. An answer of No and Yes would not be able to help us to help you.
EXAMPLE OF WHAT HERBS YOU WOULD TAKE
Case 1: Helen has breast cancer and one breast has been removed. She is currently on chemotherapy. She suffered side effects like nausea, vomiting, loss of appetite. She is constipated. She has no gastric problem.
Our prescription for Helen:
1. Capsule A: 2 cap., take 3 times per day on empty stomach.
2. C- Tea: take as drinking water, 1 to 2 liters per day.
3. Breast-M: take once a day (need boiling).
4. Chemo-Tea: take once a day while on chemotherapy.
5. Constipation Tea: take when necessary.
Case 2. James has colon cancer that has spread to the liver. His stomach is bloated and distended. He is in severe pain.
Our prescription for James:
1.Capsule A + B: 2 cap. A and 2 cap. B, take 3 times per day with honey water.
2. LL-Tea: take as drinking water, 1 to 2 lietes per day.
3. Liver-P: take once a day (need boiling).
4. Abdominal Distension Tea:for the bloated stomach, take once a day.
5. Pain Tea: take 3 to 6 times per day.
Information Required on First Visit Form
Full Name:
Age:
Gender: M / F
Part 1: Medical history
Cancer: Type, stage and extent of spread (metastasis).
How it started, what doctors you have seen and the treatments given. You MUST provide us with copies of all medical reports.
Part B : Your Current Medications
Are you currently on any herbs? If yes, are they effective? Give details. We request you to stop all other herbs if you wish to start with our herbs. You may continue to take your doctor’s medication, nutrients and vitamin supplements but list down what you are taking.
Part C: Your Current Health
The more details you provide, the better we can understand your problems.
1. Are you in pain? Where, how often/serious?
2. Can you sleep? Elaborate.
3. Feeling tired?
4. How often is your bowel movement? Difficult, constipated, with blood?
5. How is your appetite?
6. Any swelling? Where?
7. Do you have: Gastric problems? Diabetes? High blood pressure?
8. Urination – frequency? painful? with blood?
9. Cough? What phlegm colour (white/yellow). Itchy throat?
10. Difficulty in breathing? Elaborate.
11. List and explain any other complaints.
Disclaimer and Release of Liability
Particulars of patient:
I,__________________________________________
IC/No________________________
Address:________________________________________________________________
being of age and sound mind, and who is suffering from cancer of: ________________ hereby voluntarily make the following declaration that:
1. I have on my own free will, come to seek advice and help from Dr. Chris K H Teo and members of his CA Care team (being a project of Teo Herbal Centre) with regards to my illness. I acknowledge that there is no guarantee or promise that the herbs provided by CA Care can benefit me or cure my sickness. I am aware that I shall be taking the herbs prescribed to me on my own free will and choice and at my own risk. I declare that I shall not under any circumstances hold Dr. Chris KH Teo or any members of his CA Care liable in the event that problems or complications arise from the consumption of such herbs.
2. I am fully aware that Dr. Chris K H Teo and members of his CA Care are giving his/her/their advice free of charge and in good faith to help me with my sickness, which I know is serious. I am at full liberty to accept or reject the advice given to me. I understand that any payment I make is for the cost of herbs and/or supplies only.
3. I also acknowledge that Dr. Chris K H Teo and the members of CA Care have advised me to go for whatever medical treatments necessary and that I am fully responsible for my choices of treatment.
4. I am aware that Dr. Teo and his team are collecting and documenting data on cancer and that my case history is part of this research effort. My consultation sessions with Dr. Teo are video-taped and I have no objection to this. However, in the event that my case history is being documented and published, my real name cannot be used without my permission. Similarly, video clip(s) of me cannot be used without masking my face to hide my identity, unless with my prior permission.
I make this declaration to release Dr. Chris K H Teo and members of CA Care from any liability and responsibility, and hereby put my signature as below:
Signature: _________________________ Name:
Witness: ___________________________ Name:
Dated: ____________________________ at 5, Lebuhraya Gelugor, Penang.
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