General Patient Information

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Please provide date of birth

Consent Forms

Effective Date: 10/15/2019

This website Roseto is a subscription-based website that provides access to protocols for proactive health solutions as an informational service. Your subscription (“Subscription”) to the Site is made available to you by the clinic where you receive health services (“Clinic”), and provides you with web and mobile device access to the Site.

These Terms of Service (“Terms”) are a legal agreement between you and the Clinic and govern your use of the Site and Subscription. Your access to the Site is conditioned upon your acceptance of these Terms, and you should not register for a Subscription or use the Site if you do not agree to these Terms.

1. THIS SITE DOES NOT PROVIDE MEDICAL ADVICE.

THE CONTENTS OF THIS SITE, INCLUDING PROTOCOLS, DIAGNOSTIC AND PATIENT MANAGEMENT METHODS, TESTING RESULTS, AND ALL OTHER INFORMATION (“CONTENT”) IS FOR PERSONAL INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO BE AND SHOULD NOT BE USED FOR OR AS A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. THIS SITE IS NOT INTENDED FOR USE BY INDIVIDUALS WHO ARE UNWILLING OR UNABLE TO MAINTAIN CONTACT WITH THEIR HEALTHCARE ADVISER.

2. Registration, Username, and Password.

When registering for a Subscription to the Site, you agree to provide your current, complete, and accurate information. You are responsible for keeping your username and password confidential. If you allow your account to be accessed by another individual who you authorize, you and that other individual acknowledge that all Content is designed for your use and not for anyone else, and you must inform them and obtain their agreement to these Terms. By using the Site, each user agrees to and is bound by these Terms. You agree that Clinic may attribute all use of your username to you and that you are responsible for all activity that occurs with your username and password. Please notify Clinic immediately if the security of your username or password has been compromised.

3. Purchasing Supplements through the Site.

If you purchase or sign-up for auto-renewal of purchases of any supplements through the Site, you agree to provide accurate contact and billing information. Clinic may request an alternate form of payment if your payment cannot be processed. By purchasing supplements through the Site, you authorize the Clinic and Site’s third party payment processor to use the payment method you enter to make purchases through the Site. You must comply with any such third party payment processor’s terms made available to you. If you do not agree to these terms, then please do not purchase or sign up for auto-renewal of supplement purchases through the Site.

4. Subscription Term; Cancellation.

The term of your Subscription begins on the date you acquire a Subscription and continues in accordance with your agreement with the Clinic. Your Subscription may be cancelled in accordance with your agreement with the Clinic or if you breach any of these Terms.

5. Data Charges and Requirements to Access Site.

You may need to use or obtain additional products or services in order to use your Subscription, such as a device, internet access, or a data connection. You must obtain or use these products or services separately and pay all associated charges (including for internet access or other data transmission).

6. Appropriate Use of the Site and Content.

The Site and Content is provided to subscribers for individual, personal, and non-commercial use. Use of the Site or Content for any purpose other than what is described in these Terms is prohibited. You may not attempt to decompile, reverse engineer, create derivative works from, disassemble, unlock, copy, or recreate any component or part, or attempt to derive the source code, of the Site. You further agree not to interfere with the proper functioning of the Site or use of the Site by others.

7. Site Availability.

You may access the Site if and when it is available. Availability of the Site or Content is not guaranteed. The Site may occasionally be down for service, upgrades, or for other reasons.

8. Privacy.

(a) Personal Information will be collected, used and disclosed in accordance with the Clinic’s privacy policies, as supplemented and amended as set out in subsections 8(a) and 8(b) of these Terms, and Applicable Privacy Laws.

(b) Personal Information inputted or stored through the Site and the Subscription may be transferred to, stored and processed by the Site Supplier (as defined below) in Canada and any other country outside of Canada where the Site Supplier or its service providers maintain facilities. By using the Site and the Subscription, you consent to this transfer. Your Personal Information may be subject to disclosure under the laws of those jurisdictions and it may be accessible to law enforcement and national securities authorities of those jurisdictions. If you would like any more information about the Site Supplier’s use of foreign service providers to process Personal Information, please contact the Site Supplier at the address provided at the end of these Terms.

(c) Your Personal Information may be used by the Site Supplier to generate Anonymous Aggregated Data that may be used and commercialized for the purpose of researching and improving health outcomes, but in no event whatsoever will Anonymous Aggregated Data reveal (or be used to reveal) your identity or the identity of anyone else. Anonymous Aggregated Data will be the property of the Site Supplier.

(d) Like most other commercial websites, the Site may automatically monitor traffic patterns, site usage and related site information. The Site may automatically collect or compile certain information when you access the Site. Examples of this type of information include the aggregate and unique number of visitors to the Site, the dates and times of visits to the Site, the domains/countries of visitors, the pages of the Site visited and the content accessed, the browsers, operating systems, search engines and search terms used to visit the Site and HTTP errors generated. The Site Supplier and its contractors use this information to administer the Site, optimize the Site, and to assess usage of the Site.

(e) The Site uses cookies. A cookie is a small file of letters and numbers that is stored on your browser or the hard drive of your device. Cookies are required for the operation of certain features of the Site, such as to log into secure areas or use a shopping cart. Cookies are used to distinguish you from other users of the Site, which helps to provide you with a good experience when you browse the Site and to improve the Site. You block cookies by activating the setting on your browser that allows you to refuse the setting of all or some cookies. However, if you use your browser settings to block cookies, parts of the Site may not work properly.

(f) For purposes of this Section 8 of these Terms:
(i) “Anonymous Aggregated Data” means records which have been stripped of information identifying individuals, and which have been manipulated or combined to provide generalized anonymous information.
(ii) “Personal Health Information” includes identifying information about an individual, whether living or deceased, in both recorded and unrecorded forms, and including information that:
(A) relates to the physical and mental health of an individual, including information that consists of the health history of the individual’s family;
(B) concerns any health service provided to the individual;
(C) concerns the donation by the individual of any body part or any bodily substance of the individual or information derived from the testing or examination of a body part or bodily substance of the individual;
(D) is collected in the course of providing health services to the individual; or
(E) is collected incidentally to the provision of health services to the individual.
(iii) “Personal Information” means information about identifiable individuals and includes Personal Health Information and any other information that is defined as such according to Applicable Privacy Laws.
(iv) “Applicable Privacy Laws” means, as may be applicable in the circumstances, (i) the Personal Information Protection Act (Alberta); (ii) the Health Information Act (Alberta); and (iii) the Personal Protection and Electronic Documents Act (Canada).

9. No Warranties.

TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, THE SITE AND ALL CONTENT IS PROVIDED “AS IS” AND “AS AVAILABLE” AND ALL REPRESENTATIONS, WARRANTIES, OR CONDITIONS, EXPRESS, IMPLIED, OR STATUTORY ARE EXCLUDED, INCLUDING THOSE OF MERCHANTABILITY, MERCHANTABLE QUALITY, DURABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. CLINIC AND THE SITE SUPPLIER MAKE NO REPRESENTATION OR WARRANTY THAT THE SITE OR CONTENT: (A) WILL MEET YOUR REQUIREMENTS; (B) WILL BE AVAILABLE OR PROVIDED ON AN UNINTERRUPTED, TIMELY, SECURE, OR ERROR-FREE BASIS; (C) WILL BE ACCURATE, COMPLETE, OR RELIABLE, OR (D) WILL BE FREE FROM VIRUSES, WORMS, OR OTHER HARMFUL OR MALICIOUS COMPONENTS. THE SITE AND ALL CONTENT YOU DOWNLOAD OR OBTAIN FROM THE SITE IS ACCESSED AT YOUR OWN RISK.

10. Disclaimer of Certain Damages; Limitation of Liability and Exclusive Remedies.

IN NO EVENT WILL CLINIC OR THE SITE SUPPLIER BE LIABLE FOR ANY DIRECT, CONSEQUENTIAL, SPECIAL, INCIDENTAL, INDIRECT, OR PUNITIVE DAMAGES OF ANY NATURE OR KIND CAUSED BY OR ARISING OUT OF YOUR USE OF OR ANY DEFECT IN THE SITE OR THE CONTENT, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOUR SOLE REMEDY, AND CLINIC’S AND THE SITE SUPPLIER’S SOLE LIABILITY, FOR ANY AND ALL DAMAGES, INJURIES, AND LOSSES ARISING FROM ANY AND ALL CLAIMS AND CAUSES OF ACTION ARISING OUT OF OR RELATING TO YOUR USE OF OR ANY DEFECT IN THE SITE OR THE CONTENT WILL BE TO DISCONTINUE USE OF THE SITE AND CONTENT.

11. IMPORTANT NOTICE.

CERTAIN LAWS DO NOT ALLOW LIMITATIONS ON IMPLIED OR STATUTORY WARRANTIES, OR THE EXCLUSION OR LIMITATION OF CERTAIN DAMAGES. IF THESE LAWS APPLY, SOME OR ALL OF THE ABOVE DISCLAIMERS, EXCLUSIONS OR LIMITATIONS MAY NOT APPLY TO YOU, AND YOU MAY HAVE ADDITIONAL RIGHTS TO THOSE CONTAINED HEREIN.

12. Modifications to these Terms.

Clinic reserves the right to change these Terms (including any referenced terms or policies) at any time upon notice to you. You agree to periodically review these Terms for changes. Updated Terms are binding on you as of the effective date noted at the outset of these Terms. Your continued use of the Site after the effective date indicates your acceptance of the updated Terms, even if you have not reviewed them. If, at any time, you do not agree to the Terms, you should cancel your Subscription and stop using this Site.

13. Reservation of Rights.

Any and all rights, titles, interests, copyrights, and other intellectual property rights in the Site belong to the Site Supplier. Except as expressly provided in these Terms, nothing contained herein shall be construed as conferring any license or right, by implication, estoppel or otherwise, under copyright or other intellectual property rights.

14. Governing Law and Exclusive Jurisdiction and Venue.

These Terms are governed by, and are to be construed and interpreted in accordance with, the laws of the Province of Alberta and the laws of Canada applicable in that Province without applying any conflicts of law principles that would apply a different body of law. You expressly submit and attorn to the exclusive jurisdiction of the courts of the Province of Alberta to determine all issues, whether at law or in equity, relating to or arising from these Terms, the Site or the Content.

15. General.

If any provision of these Terms is determined by a court of competent jurisdiction to be illegal, invalid, or unenforceable, the remaining provisions of these Terms will remain in full force and effect. Section titles are only for convenience and have no legal or contractual significance. Clinic may assign these Terms, in whole or in part, at any time, with or without notice to you. You may not assign, transfer, or sublicense your rights, if any, in your Subscription. These Terms (including any referenced terms or policies) constitute the entire agreement between you and Clinic with respect to your Subscription, the Site and Content. No waiver of any provision of these Terms will be construed as a waiver of any other provision hereof, nor will such waiver be construed as a continuing waiver.

16. Enurement; Site Supplier.

These terms will enure to the benefit of and be binding on the parties and their respective successors, heirs, executors, administrators and permitted assigns. The Site is provided to the Clinic and powered by Roseto Health Innovations Ltd. (the “Site Supplier”),

#228, 2031 33 Ave SW

Calgary, AB

T2T 1Z5

403-703-2289.

These Terms shall also enure to the benefit of the Site Supplier, and you agree that, in addition to the Clinic, the Site Supplier shall be entitled to enforce these Terms against you.

Medical History

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Family Medical History

Please list any conditions, illness, and/or disease of Mother, Father,
and Siblings. Please include age and cause of death of family members if applicable.

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Please choose the option

Siblings

Please choose the option
Please choose the option

Lifestyle and Social History

Your day to day activities and habits have a long term effect on your overall mental and physical health. The questionnaire below helps us understand your current lifestyle so we can better serve your proactive health care plan.

Food

Please select a % beside each option to indicate how much of this is in your diet.

Whole Fresh Foods

%

Fast food or processed prepackaged foods

%

Restaurants & Dining out

%

Drinks

Please select a volume beside each option to indicate how much is in your diet.

Litres/Day
Glasses/Day
Glasses/Day
Glasses/Week
Cups/Day

Exercise

Please indicate the volume beside each option to determine the effect on your lifestyle.

Aerobic Activities

# of minutes/week

Strength Activities

# of minutes/week

Restorative Activities

# of minutes/week

Stress & Social Support

Please assess the quality of your sleep

How many hours of sleep do you get every night?

Please assess your levels of stress

Please assess your social support network

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