Informed Consent Agreement

This Informed Consent Agreement ("Agreement") outlines the terms and conditions of the psychotherapy services ("Services") offered by the Nairobi Bariatric Center ("Clinic"). By signing this Agreement, you are consenting to participate in the Services, and you agree to abide by the responsibilities and terms outlined below:

1. Program Overview

The Psychological Correction of Eating Habits Program ("Program") addresses multiple factors linked to obesity: psychological, social, metabolic, anatomical, and environmental. Traditional dieting often fails by not addressing these factors holistically.

Our treatment uses a personalized, integrative approach seeing the individual as a whole. We employ evidence-based behavioral interventions, specifically the "Psychological Correction of Eating Habits" method by Dr. Varaksin and Dr. Shchukina.

2. Program Schedule

The Program includes weekly 1.5 hour online group therapy psychoeducational sessions, calorie education and psychotherapy training materials. 

The duration of the course is 4 months, typically on Saturdays from 8-9:30 am on Zoom. In the first month the patient will not start group therapy but will however listen to the provided audio sessions and work on their food diary closely with the nutritionist to achieve set goals. The patient will then join group therapy sessions for three months while continuing with the programme started in the first month.Patients should acquire supportive tools, such as natural food supplementation, individually. Sessions cannot be made up, transferred, or refunded if missed.

3. Participant Responsibilities

As a participant of these Services, you are required to:

1. Attendance: Regularly attend all sessions as scheduled, including group activities. This includes:
   1. Log in punctually and inform of delays
   2. Provide 1 day notice for missed sessions
   3. Confirm next appointments at session end
2. Engagement: Actively participate in the sessions, engage with the group, and contribute to a positive, respectful, and constructive atmosphere. This means:
   1. Silence phones during sessions
   2. Speak respectfully and orderly during the group therapy
3. Homework: Maintain a daily updates food and mixed dishes diary, and count calorie intake as instructed. This includes:
   1. Complete any assignments provided by the Clinic
   2. You are required to bring your diaries to every session
4. Listening to Audio Sessions: Regularly listen to all audio sessions provided as part of the Services.
5. Discontinuation: participants who miss more than 6 of the 12 sessions will be automatically discontinued from the program

Failure to fulfill these responsibilities can hinder your progress in therapy and may impact the efficacy of the Services for you and other group participants. Therefore, it is essential to commit to rigorously follow the program.

4. Payment Terms

The non-refundable Program fee is Ksh 42,000, payable upfront before the first session. This covers all Program elements, resources, and staff time committed solely for your treatment.

5. Fee Policy

The cost of the Services is non-refundable and non-transferable. By agreeing to this term, you acknowledge that you have made an informed decision to participate in these Services and will be financially responsible for the full cost of the Services.

The Services require significant resources and preparation by the Clinic. Upon your agreement to participate and payment of the fee, these resources are committed for your use, and they cannot be easily redirected. Consequently, if you choose to discontinue the Services at any point, your payment cannot be refunded nor transferred to other services or programs.

6. Confidentiality

Patients must uphold strict confidentiality of all group discussions, activities, and member identities. The Center also maintains confidentiality around personal health records as required by law.

By signing below, you confirm your understanding of the above terms and consent to participate in the Program under these conditions. You were provided opportunities to ask questions and consult with legal counsel if desired.

7. Agreement

By signing below, you acknowledge that you have read and understood this Agreement, and you accept all terms and conditions as set forth herein. This Agreement serves as a contract between you, the patient, and the Clinic.

You further acknowledge that any questions you had about this Agreement were answered to your satisfaction, and you were provided sufficient opportunity to consult with legal counsel, should you choose to do so.