OLOPROTEIC DIET VIRTUAL CLINIC

INFORMED CONSENT for NUTRITIONAL CONSULTING

The user [Name Surname], through registration on the OLOPROTEIC DIET VIRTUAL CLINIC platform, as identified via the LOGIN-PAGE, subscribes to this private agreement in order to proceed with conferring the professional assignment for remote consulting.

The consent is considered collected for the purposes of the punctual application of community directives 97/7/EC, 93/13/EEC, 85/577/EEC, 2001/95/EC, 2011/83/EU, 1999/44/EEC, which protect all consumer rights regarding consent, misleading advertising, clarity on services to be rendered, informed consent, consumer forum and 2011/24/EU on cross-border healthcare.

Having said this, the user [Name Surname]

DECLARES

• 1. That they wish to entrust OLOPROTEIC DIET VIRTUAL CLINIC, in the person of its director, Prof. Giuseppe Castaldo MD assisted by expert nutritionists, with the professional assignment for the evaluation of their nutritional status, their nutritional and energy needs and the elaboration of an optimal personalized diet;
• 2. This assignment runs from the acceptance and submission of this web form (HTML form) and is considered conferred until the conclusion of the requested professional service;
• 3. That they have fully understood the advantages, limits, and potential complications of the dietary regime that will be recommended to them, in particular:
  • a) for the dietary regime that will be recommended, the Nutritionist will prescribe food supplements, for which they will receive information from the sites kirosdiet.com (or other domain attributable to Kirosdiet) and from one of the domains directly attributable to OLOPROTEIC DIET VIRTUAL CLINIC (for example, oloproteicdietclinic.it), or via private messaging (example, WhatsApp, other short ways) to explain their utility, methods of use, indications, contraindications, and possible side effects;
  • b) that they understood that the percentage of positive results of the dietary regime will depend on the individual responses of the organism;
  • c) that they understood that, for the maintenance of good nutritional balance over time, periodic check-up sessions are appropriate;
  • d) that they have been informed about the behaviors to keep, technical times, and advice to follow during the period of the recommended dietary regime, aware that otherwise the final result could be compromised and, given the nature of the treatment I decide to undergo, it is not possible to guarantee nor establish a priori precisely the exact final result;
  • e) that they were given the opportunity to ask questions via messaging or the Online Visits Platform App about my condition and the dietary regime that will be recommended to me.
• 4. to commit to correctly filling out the anamnesis and in particular to report with precision any pharmacological therapies carried out in the past or still in progress, current or previous pathologies and/or surgeries, allergies, and life habits.
• 5. to commit to promptly communicating any possible prescription or variation of therapy with supplements or drugs prescribed by other doctors during the nutritional program.
• 6. to have fully understood what the potential links and risks could be with respect to functional suggestions and suitable for their nutritional and energy needs proposed by Prof. Giuseppe Castaldo and his team of nutritionists.
• 7. not to omit declaring anything regarding my current and past psycho-physical state and to have attached in the evaluation form the results of current health checks undergone and to send results of any new exams, even if prescribed by other doctors, carried out during the period of validity of the prescribed nutritional program. It will be their exclusive responsibility to promptly inform Prof. Giuseppe Castaldo and his team of nutritionists should symptomatic variations of their psycho-physical state occur that are related to the conferred assignment, exonerating from any responsibility for lack of communication or omission of checks.
• 8. to be informed that the weight loss method developed by Prof. Giuseppe Castaldo MD, applied in thousands of cases, provides for various dietary typologies such as the Oloproteic Diet, which is a ketogenic diet with very low calorie and carbohydrate content, the LOGI Slimming diet (non-ketogenic diet with low glycemic and insulinemic content), LOGI Maintenance Diet and DETOX Days.
• 9. to be aware that taking into account the anamnesis, their nutritional data, and my nutritional objectives, Prof. Giuseppe Castaldo and his team will elaborate a personalized diet foreseeing its integration and duration.
• 10. to be informed that for the safety of the diet it is necessary to scrupulously adhere to the protocol also respecting the duration of every single step.
• 11. to be aware that in particular the Oloproteic Diet is a therapy whose safety is strictly connected to compliance with the protocol and that in any case they commit to communicating any real or presumed side effect deriving from the diet at the first manifestation of symptoms.
• 12. to be informed that however, during the execution of the Oloproteic Diet, even while respecting the protocol, side effects generally of little significance could manifest, such as: dizziness, nausea, asthenia, constipation, diarrhea, headache, halitosis, palpitations, cramps.
• 13. to have been informed that in the case of Oloproteic Diet, which is a ketogenic diet or VLCKD, there are absolute contraindications for its prescription: cardiac arrhythmia, ongoing pregnancy/breastfeeding, renal insufficiency, medium/severe hepatic insufficiency, type I diabetes, psychiatric pathologies. All situations which, if existing, they have diligently recorded in the anamnesis and nutritional evaluation forms.
• 14. to have been informed that for the performance of the services object of this assignment the compensation of Prof. Giuseppe Castaldo and his team of nutritionists corresponds to what is indicated on the Oloproteic Diet Virtual Clinic sites for the First Visit or the Control Visit for Remote Nutritional Consulting.
• 15. to have understood that the Remote Consulting service includes the prescription of the Diet and the related therapy with supplements, Assistance on the Nutritional Path and Nutritional Advice, which will be sent via messaging or App when activated, for the entire period of validity of the single nutritional plan.
• 16. To be aware that it will be their task to inform and send to their own general practitioner the prescribed dietological program, communicating any observations of the same to Prof. Castaldo and his team of nutritionists.
• 17. gives consent for the anonymous use of clinical data for scientific works, clinical studies, and health statistics.
• 18. to have been informed that the law applicable to this relationship, limited to its health profile, is that in force in Italy, where OLOPROTEIC DIET ITALIA SRL has its registered office, as well as regulated by EU directive 2011/24/EU.

I declare to have read and understood the above and am satisfied with the information provided to me, consciously and spontaneously
I give my consent to receive and follow the dietary regime that will be recommended to me.

Specific Approval