Provider agrees to perform a quantitative electroencephalogram ("qEEG") diagnostic assessment, prepare a written report of findings, and provide a recorded interpretation of results (collectively, the "Service"). The Service is a one-time diagnostic consultation only.
I acknowledge and agree to the following:
A limited provider-patient relationship is established solely for the purpose of performing and interpreting the qEEG
Provider will not prescribe medications, order laboratory tests, or manage ongoing treatment as part of this Service.
Provider is not Patient's primary care provider, general naturopathic physician, or ongoing treating physician as a result of this Service.
Results and findings are intended to be used in conjunction with Patient's existing or future healthcare providers.
Patient is responsible for seeking follow-up care, treatment decisions, and ongoing medical management with a provider of their choosing.
qEEG findings are adjunctive clinical information and should be interpreted in conjunction with clinical history, examination findings, and other diagnostic information. qEEG findings alone should not be considered a definitive diagnosis of any neurological, psychiatric, or medical condition.
Arizona law recognizes the right of patients to seek limited-scope diagnostic consultations. This agreement is consistent with A.R.S. § 32-1501 et seq. governing the practice of naturopathic medicine in Arizona.
EDUCATIONAL MATERIALS - Dr. Pingel's video and materials explain the report in general terms - This is educational information, NOT medical advice for my specific situation - I must discuss all results with my referring provider before taking any action.
PAYMENT & CANCELLATION - Payment details are collected at the time of booking and charged 24-48 hours prior to appointment. Once your appointment is approved, we reserve the right to charge your card for service and there are no refunds given within 48 hours of our appointment time. One re-schedule is allowed.
