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Chelation Therapy Informed Consent Agreement - Dr Bloem - drbloem

Chelation Therapy Informed Consent Agreement - Dr Bloem - drbloem 2025

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The document is an informed consent form for intravenous EDTA chelation therapy, authored by Dr. Fred Bloem. It outlines the purpose of the therapy, which includes treating atherosclerotic disease and heavy metal toxicity, while noting its controversial status in the medical community. The patient acknowledges understanding the potential benefits, risks, and alternative treatments, as well as their right to discontinue treatment at any time. The form emphasizes the importance of a healthy lifestyle for optimal results and requires the patient to provide medical history and agree to regular follow-ups.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field at the top of the form, ensuring accuracy for identification purposes.
Read through the consent details carefully. This section outlines the purpose and potential risks associated with Chelation Therapy. Make sure you understand each point.
In the signature area, sign your name to indicate your consent. If applicable, include the name of a parent, legal guardian, or caregiver.
Initial each page as required to confirm that you have read and understood all information provided.
Finally, enter the date of signing in the specified field to complete your agreement.

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