|
|
Health Providers Network |
If you would like to be listed as a professional who knows about using EFs, please fill out the form below. If you are also interested in foods and supplements or lecturing, please fill our nutrition network form.
We are seeking to identify doctors and nutritionists who are interested in helping patients to modify their risk factors and change their fatty acid profiles by modifying the balance of fatty acids in their diets. We have educational materials for patients and health providers on suggested treatment plans to achieve optimal nutrition.
We are also interested in developing collaborations for research presentations. We will have a free newsletter, tutorials on the Internet and on floppy disks, and other educational materials which you can provide to your patients. We are also making arrangements to obtain high quality oils and supplements.
During our lectures and meetings with lay organizations and members of the press, we are frequently asked to identify health providers who are familiar with fatty acid metabolism and can assist patients to improve their lipid profiles.
If you are interested in treating patients with fatty acid abnormalities using different nutritional therapies, we would like to add your name to our health provider nutrition network. Eventually we plan to prepare a directory of health providers in each major area of the USA.
There is no charge for this service. However, we assume no responsibility for any referral or any consequence of the diagnosis or treatment that you provide. Our purpose is mainly to assist patients find an appropriate health provider. We make no recommendations, and we cannot assure you of any referrals. We ask you to sign the enclosed agreement which primarily releases us from any liability or responsibility pertaining to any diagnosis or treatment you may provide to your patients.
|
Health Provider List Form Please provide all the information that you would like to have released to the general public. We reserve the right to print only portions of the information below or to exclude you from our listings for any reason. This is a very low budget process and we will rarely check the accuracy of the information you provide us. We are not responsible for any errors. First, Last Name _______________________________________________ Address (Office) _______________________________________________ Phone ______ - ______ - ____________ Medical/Health Education (School, year graduation). ___________________ Specialty Board Certification ______________________________________ Licenses you have (MD, DC, RD, etc.) (states) ________________________ Languages you Speak other than English: _____________________________ Medical/Nutritional Areas of Practice: ______________________________ Hospital affiliations, if any: _______________________________________ Any other information you consider relevant. __________________________ |
Sign the statement below:
|
RELEASE OF LIABILITY In what follows, the words "you" refers to Dr. Siguel, any of his associates, any corporation he works for, or EssentialFats LLC. I agree to have any part of the above information provided to the general public through any means of distribution of information, including electronic means, bulletin boards, public media, mail or directories. I am a _____________ licensed to practice ________________ in the state of ________________. I am in good standing with the ______________________ (Board of Medicine, etc.). I am not subject to disciplinary action. I carry _________________ malpractice insurance. I have education, training and experience that qualifies me to evaluate patients for lipid abnormalities and, where appropriate, to order necessary blood tests. I am also familiar with disorders of fatty acid metabolism and I am qualified to prescribe appropriate diets to patients. In consideration for providing my name to potential patients, I agree to hold you harmless for any liability you may incur as a result of the fact that I see a patient who obtained my name from you. I will reimburse you for any liability incurred from any referral I receive from you. I understand that I am free to choose any form of diagnosis or treatment that I consider appropriate for my patient. If I choose to see a patient who obtained my name from you, I will be responsible for any diagnosis or treatment I provide to that patient. I am free to accept or reject any patient and treat any patient who obtained my name from you in the same manner that I would treat any other patient who obtained my name from a telephone book. Signed, __________________________ This ____ day of _______, 199_. |
|
|
Your tax-deductible donation supports research by the non-profit foundation National Center for Nutrition and Fatty Acid Research, Inc. Please help us bring you useful information. NCNFAR, PO Box 10187 Dept C, Gaithersburg, MD 20898. |
|
By
reading this web site, you agree to read & comply with the following
instructions: You agree to pay us $300 for each unsolicited communication to sell us unsolicited products/services (by e-mail, mail, phone, etc.). Read details. |
|
|
© 1998 Edward N. Siguel. All rights
reserved |
modified 1/15/00 |