Download Health Institute de Tijuana, Mexico Clinic Application

Health Institute de
Tijuana, Mexico
Clinic Application
Dear Sir or Madam,
Thank you for your interest in the Gerson Therapy. To be considered for admission to the licensed facility in Mexico,
H.I. de Tijuana S.C., your case needs to be evaluated by the clinic's doctors, to make sure that you are physically able
to do the Gerson Therapy.
H.I. de Tijuana S.C. is located in Playas de Tijuana, Mexico. This clinic is a separate, privately-owned business run by
Gerson-trained doctors. However, it is licensed by the Gerson Institute, which ensures that patients receive true
Gerson care.
Your case can be evaluated at no charge, a service that the Gerson Institute facilitates as a non-profit organization.
We also coordinate the application process for patients considering going to the clinic.
The minimum stay at the clinic is two weeks but we recommend a three-week stay for optimal results. The cost for
the treatment is $5,500 US per week. Patients are required to bring a companion - i.e. spouse, relative, friend- to
assist the patient during their stay. The $5,500 US per week includes room and board for the companion.
Please submit the medical records on the attached list along with the enclosed Medical Summary and Medical
Records Release forms. After the Gerson clinic doctors have reviewed all the information, we will contact you
within four business days. If you are approved, we will send you an Admission packet with information on payment,
transportation, what to bring, and permission forms.
We look forward to hearing from you.
Sincerely,
Education Department
The Gerson Institute
PO Box 161358
San Diego, CA 92176
P. 858.694.0707
F. 858.694.0757
[email protected]
www.gerson.org
Page 2 of 12
Contraindications and Cautions Before Applying to the Clinic
While the Gerson Therapy is remarkably effective at treating a wide range of chronic degenerative diseases, some conditions
require significant modifications to the treatment, and for others the Therapy is not recommended at all. Before applying to
the clinic, please read the information below on precautions that should be taken for certain diagnoses.
Surgical considerations for early-stage breast cancer patients
The Gerson Institute would like to make all breast cancer patients aware that through the years the Gerson Doctors have
observed that the benefit of the Gerson Therapy is enhanced when the body does not have to break down a tumor mass first
while trying to eliminate other infiltrating cancer cells.
Each case needs to be evaluated individually based on the size of the tumor, the histopathology report indicating how
aggressive the cancer is which can be discussed with your doctor. However, for a patient with a recent breast cancer
diagnosis of a Stage I-III with a small tumor, surgery should be considered.
The patient may choose to have surgery before starting the Therapy or apply the Therapy for several weeks to enhance
immunity and then have the surgery.
If one elects to not have surgery, then it is advisable to monitor the size of the tumor mass closely with an MRI on a regular
basis and if the tumor is not getting smaller, then one should reconsider the option of surgery.
Multiple Myeloma
Multiple myeloma is a malignancy of plasma cells, which are white blood cells that make antibodies. These cells invade and
destroy adjacent bone tissue. Multiple myeloma produces non-solid tumors, and is somewhat similar to leukemia.
The Gerson Therapy has encountered challenges in dealing with multiple myeloma, especially since discontinuing the raw
liver juice. A patient may initially reap some benefit from the nutrition and detoxification the Therapy provides, but we have
not seen sustained benefit. So, the Gerson Therapy may not be advisable as a sole treatment. If someone decides to pursue
the Gerson Therapy, they may be advised to integrate certain conventional therapies such as bisphosphonates, a line of
prescriptions drugs that help to slow down bone breakdown. They will also need to introduce additional protein into the diet
earlier.
Chronic Fatigue Syndrome/Chemical Sensitivity and Fibromyalgia
Many of these patients have lead or mercury poisoning and may be Epstein-Barr virus (EBV) positive. The Therapy can work
well for these conditions, but patients may not see significant improvement for a few months and they may experience many
ups and downs during this time. They may feel worse (more toxic or depleted) in the early stages of the Therapy, especially
after coffee enemas. Because of these strong detox reactions, which can include depression, crying and anger, the clinic
prefers people to start the treatment at home and is not accepting applications with this condition at the present time.
Contact the Gerson Institute to find out other services to help you start the Gerson Therapy at home.
Pacemakers
A pacemaker is a foreign object and the Gerson Therapy has the potential to stimulate a healing reaction at the site of the
pacemaker. This could cause a cardiac emergency and be very dangerous to the patient and put their life at risk. It is possible
to apply a much reduced version of the Therapy for overall health enhancement, but would not likely to be enough to heal a
cancer diagnosis. However, it may be possible to follow a very reduced protocol at home and improve one's overall health
condition. This advice also applies to cardiac stents and cardiac valve replacements.
The clinic is not accepting applications with this condition. Contact the Gerson Institute to find out other services to help you
start the Gerson Therapy at home.
Page 3 of 12
Sarcoma
It must be noted that sarcomas are difficult cancers to treat unless diagnosed early when the size of the tumor is small and
can be easily excised with clear margins, and there have been no metastasis. Under these circumstances patients will have
the best chance of doing well on the Gerson Therapy and will be considered for treatment at the clinic. However, if a patient
has a more advanced condition than described above, it is unlikely they will be accepted at the clinic and should consider
alternatives to using Gerson as a stand alone treatment.
The clinic is not accepting patients with any of the following conditions:
∙
organ, stem cell or bone marrow transplant recipients
∙
on kidney dialysis
∙
acute leukemia
∙
brain cancer or brain metastases
If you have any further questions about the application process or your specific condition, don't hesitate to contact our
Education Department at 858.694.0707 or at [email protected].
Page 4 of 12
Exceptions to the two-week minimum stay
The clinic will allow some nonmalignant patients to come to the clinic for 1 week rather than 2. All perspective
patients will still need to apply to the clinic in the same manner, and decisions for length of time will be at the
discretion of the clinic. Patients accepted for 1 week will be treated just as any other patient --laboratories, medical
consultations, foods, enemas, supplements etc. --and therefore the cost of $5,500 per week will remain the same.
Lastly, these patients will still need to bring a companion unless otherwise directed by the clinic.
See the list below for conditions that HI de Tijuana may be willing to accept for 1 week:
·
Detox, healthy patient
·
Diabetes, type 2
·
Obesity
·
Hyperlipidemia
·
Degenerative Arthritis
·
Glaucoma
·
Heavy metal toxicity, mercury
·
Psoriasis
·
Eczema
·
Fatty Liver Disease
·
Migraines
·
Osteoporosis
·
Premenstrual Syndrome
·
Fibrocystic breast disease
When reviewing applications, the clinic will base their decision for 1 week acceptance on a patient's condition and
overall health. The clinic has the right to recommend a minimum two-week if they feel it is best for patient's treatment.
How to submit your application:
· Fax your application and all required document at +1.858.694.0757 or mail it to the Gerson Institute to:
4631 Viewridge Ave, San Diego, CA 92123. We cannot accept applications by e-mail.
· If you live outside the U.S., please fax your application and required documents. We don't recommend sending the
application by regular mail, as this may delay the evaluation.
· At this time, we are only accepting medical records and laboratory reports in English or Spanish.
What needs to be included in your application:
·Please see the Required Documents Checklist below, which details the medical records and laboratory reports that are
required.
·Please do not submit your application until it is complete and includes all the required documentation.
·Please do not send more than 30 pages total. If you have more than 30 pages, please choose the most relevant medical
reports from within the past year.
Only send in your completed application with all the required medical records and blood work. Incomplete
applications will be put on hold until the rest of the required documents are received.
Required Documents Checklist
Medical Summary Form, pages 7-9. All fields must be completed.
Medical Records Release Form, page 10.
Photo ID (i.e. driver's license or passport)
Most relevant medical events from the past year. We are simply looking for a medical summary regarding your health
in the past year. If you don't have such documents you can write a letter summarizing your health situation.
Pathology Report (Biopsy), CT scan, MRI, Ultrasound, or X-Ray written report(s) this report must be less than
6months old at the time of submitting the application for evaluation. Please include at least one of these reports that
confirm your diagnosis.
Complete Blood Count with differentials (CBC)- This report must be less than 3 weeks old based on collection date at
the time of submitting an application for evaluation. Collection date:
Comprehensive Metabolic Panel Blood (CMP)- This report must be less than 3 weeks old based on the collection date
at the time of submitting an application for evaluation. Collection date:
Complete Urine Analysis (urine culture is not accepted)- This report must be less than 3 weeks old based on collection
date at the time of submitting an application for evaluation. Collection date:
Please call the Gerson Institute if you need samples of laboratory. If you are not able to get lab work ordered by your
doctor, laboratory reports can be obtained without a prescription through www.directlabs.com (US only).
Note: Film or CD records are not accepted.
A passport is required to travel to and from the United States. For visa requirement please visit www.usembassy.gov
Page 6 of 12
ONLINE FORM
MEDICAL SUMMARY FORM
PLEASE ANSWER ALL QUESTIONS AND PRINT CLEARLY. DO NOT USE ABBREVIATIONS.
Middle initial:
First name:
Last name:
City:
Street address:
State/Province:
ZIP Code:
Country:
Main phone:
email:
Alternative phone:
Spouse Name:
Alternative person to contact:
Relation to patient:
Phone:
Female
Age:
Male
ft
Height:
lb
Weight:
Languages you speak:
m
kg
Date of Birth:
MM/DD/YYYY
1. Primary diagnosis:
If breast cancer, complete:
Type:
ER +
ER -
PR +
PR -
HER2/neu +
Intraductal (DCIS)
Intralobular (LCIS)
Inflammatory
Intraductal
Intralobular
Other:
2. Original date of diagnosis:
6. Stage (I - IV):
Yes
7. Grade:
NOTE: You must be off of chemotherapy treatment for at least 4 weeks before applying
No
If yes, number of cycles:
9. Radiation use?
Date of last treatment:
Currently under chemotherapy
Date of last treatment:
Currently under radiation
I.V.
Yes
10. Hormone Therapy use:
No
Yes
No
11. Any surgeries within the past 5 years?
Date when treatment started:
Yes
Name of medication:
No
Date:
Description:
Date:
12. Was there any recurrences after treatment(s)?
If yes, location:
BRAC II
Date discovered:
5. Type of cancer:
8. Chemotherapy use?
BRAC I
3. Location of primary tumor (if any):
4. Describe any metastases:
Oral
HER2/neu -
Yes
No
Date:
13. Are you able to eat and drink ?
Yes
No
14. How frequent do you have a bowel movement?
times/week
times/day or
15. Are you bedridden ?
Yes
No
16. Do you have any difficulty walking ?
Yes
No
17. Do you require a wheelchair?
Yes
No
18. Are you on dialysis ?
Yes
No
19. Do you require oxygen?
Yes
No
20. Any fluid in lungs/chest cavity?
Yes
No
If yes, describe:
If yes, was the fluid removed?
Yes
Volume removed:
21. ¿Any fluid retention in abdomen ?
Yes
No
22. Do you have a colostomy ?
Yes
No
23. Do you have an ileostomy ?
Yes
No
24. Any internal or external bleeding ?
Yes
No
If yes, describe:
25. History of mental/emotional illness?
Yes
No
If yes, describe:
26.Have you ever taken any recreational drugs?
Date:
If yes, was the fluid removed?
Yes
Volume removed:
Yes
No
No
Date:
No
If yes, which ones? how much and for how long?:
27a. Have you ever smoked?
27b. Do you currently smoke?
Yes
Yes
No
No
Frequency and quantity:
Frequency and quantity:
28. Do you drink alcohol?
Yes
No
Frequency and quantity:
29. Do you do any exercise activities?
Yes
No
If yes, describe:
30. Have you recently lost weight?
Yes
No
If yes, how much and since when?
Yes
31. Have you ever been exposed to agricultural, occupational or environmental chemicals/toxins?
No
If yes, describe:
32. What do you do for a living?
33. How many hours do you work per week?
34. Where were you raised?
35. Have you had any accidents or injuries in the past?
36. Please check any of the following factors or symptoms that you are currently experiencing (check all that apply):
Asthma
Hypertension
Hepatitis
Nausea/Vomiting
Blood clotting problems
Kidney disease
History of stroke
Arthritis
Heart problems
Gluten intolerance
Diabetes Type I
Epilepsy
Celiac
Pneumonia
Respiratory problems
Diabetes Type II
Fibromyalgia/Chronic Fatigue/Chemical Sensitivity
Allergies to foods or drugs:
37. Do you have any foreign bodies?
IUD
Biliary stent
Mouth abscesses
Heart valve
Breast implants
Mercury fillings
Pacemaker
Saline
Silicone
Root canals
Organ transplant
Coronary stent - when placed?
Abdominal teflon mesh
Stem cell transplant
Steel plate/screws
Bone marrow transplant
IV access port
38. Please describe your diet
as a child/adolescent
39. Please describe your diet
as an adult (before
diagnosis)
Please describe your current diet by answering the following questions:
40. How many juices a day do you drink?
8 oz
Volume of each juice:
4 oz
When did you start taking juices?
How many of each?: Carrot/Apple:
41. How many coffee enemas do you take daily?
42. Please describe your daily meals:
Breakfast:
Lunch:
Oatmeal
Fruits
Hippocrates soup
Rice
Dinner:
Rice
Snacks:
Bacon
Tea
Pasta
Cooked vegetables
Baked goods
Vegetables
Pasta
Yogurt
Crackers
Yes
Bread
Orange juice
Cooked vegetables
Meat (chicken, beef, fish, pork)
Fruit
Eggs
Milk
Meat (chicken, beef, fish, pork)
Hippocrates soup
Carrot:
Orange:
When did you start taking them?
Do you eat an organic diet?
Yogurt
Coffee
Green:
Potato
Rye bread
Cereal
Bread
Fried foods
Potato
No
Bread
Fried foods
Fast food
Honey
Sweets
Other:
Beans
Sandwich
Fast foods
Sweets
Salad
Sweets
Salad
Other:
Beans
Sandwich
Fast foods
Apple sauce
Other:
Other:
Sweets
43. Prescription Medications
you are currently taking:
44. Supplements you are
currently taking:
45. Energy level:
N/A
Low
Medium
High
46. Pain level:
N/A
Low
Medium
High
I certify that all answers to the above questions are honest and accurate to the best of my knowledge.
Date:
Patient's signature:
Rev. 03.2015
Medical Records Release Form
I
hereby authorize the Gerson Institute
to release copies of any and all medical and administrative records to the H.I. de Tijuana S.C., that are required to be
considered for admission to the clinic.
Patient's Signature
Date
Print name
Only send in your completed application with all the required medical records and blood work.
Incomplete applications will not be accepted.
Page 10 of 12
Frequently Asked Questions about the Clinic
•
How can I apply to become a patient at the H.I. de Tijuana?
You can download the clinic application here. The application has a medical summary form that
you will need to fill out, and a list of the medical records and blood tests required for evaluation. Please
fax or mail the complete application to the Gerson Institute, as instructed on the application. We cannot
accept applications by email. Once we receive a patient's complete application, they can expect to hear
back within two business days.
•
Do I need to come in for a consultation or appointment first? Should I come to the clinic or the Gerson Institute
to apply in person?
No, the clinic doctors do a thorough evaluation of each individual case, based on the patient's
medical records and blood work, to determine if they are a good candidate for the Gerson Therapy. The
application is sent to by fax or by mail; there is no need to apply in person or come in for an appointment.
•
How quickly can I be admitted to a treatment center? Is there a long waiting list?
You must go through the application process and be accepted as a patient before we can
reserve you a room and arrange for your arrival. It usually takes about 15 days from the time a patient is
accepted to the time they can arrive to check in at the clinic.
•
Does the clinic accept any kind of payment plans? Can I pay in installments, or use a credit card?
No, the fees for the clinic can only be accepted upfront, prior to the patient's arrival at the
clinic. The clinic is usually not covered by insurance or Medicare.
•
Do I need to bring someone with me?
Yes. Every patient is required to bring a companion with them, and their fees are included in the
total cost of treatment. The patient can be a friend, relative, spouse, or any person who will be assisting
him or her with the Gerson Therapy at home.
•
What is the role of the companion? Will they undergo the Gerson Therapy as well?
The companion comes to support the patient, and to learn the Gerson Therapy, so that they can
assist the patient in continuing to implement the Gerson Therapy once they return home. Room and
board are provided for the companion, as well as three Gerson meals with three juices per day. As the
companion is not attending the clinic as a patient, they do not undergo the full Gerson protocol.
•
How many patients can stay at the clinic at one time?
There are 10 rooms at the clinic in Mexico, so we can accommodate 10 patients and their companions
at a time.
•
How do I get to the clinic? Do I fly into Tijuana or San Diego? Do I need a passport to enter the country?
Most patients fly in to San Diego International Airport, as it is the major airport closest to the
clinic. There is a paid transportation service, which can take you from San Diego down to the clinic's front
door. It is necessary to have a passport in order to re-enter the United States. Please, do not make any
travel arrangements until you have been accepted as a patient.
•
Is Tijuana safe? I've heard a lot of bad reports in the news about the drug wars down in Mexico.
While we are aware of people's safety concerns regarding Tijuana, our patients have never had
any troubles in that regard, and we take every precaution to ensure our patients' security. A paid
transportation service takes patients directly from San Diego to the clinic's front door. H.I. de Tijuana is
located in a safe, suburban neighborhood by the beach.
Page 11 of 12
Frequently Asked Questions about the Clinic (Cont.)
•
Do the doctors and staff speak English?
Yes, the doctors and staff at H.I. de Tijuana are all fluent in both English and Spanish. If the
patient does not speak English or Spanish, they will need to bring a companion who can translate for
them.
•
When will I start to see results? Will a two-week stay at the clinic be enough to rid me of my illness completely?
When a patient goes to one of our clinics, they are merely beginning the healing process. A
cancer patient will need to follow the Gerson Therapy for at least two years after leaving the clinic.
Most patients will go through their first healing reaction within the first week or two, and will begin to see
changes in their blood work in that time period as well. There is no set timeline for when a patient will
begin to see physical changes such as tumor reduction or elimination --healing is a very individual process,
and there are many variables that affect how long it can take for a patient to heal (i.e., diet, diagnosis,
whether or not a patient has already been through conventional treatments, etc).
•
What happens after I leave the clinic? Do I need to return to the clinic for check-ups?
After you leave the clinic, you will go home and continue the Gerson Therapy protocol as
prescribed by the clinic doctors. Most patients do not return to the clinic, unless they opt to return for
another stay there. Patients do follow-up consultations with the doctors by phone, by sending their
blood work and medical records for the doctors to review, so that the doctors can track their progress
and adjust the protocol as needed.
•
I am currently undergoing chemotherapy. Can I still apply to the clinic while I am taking chemo?
No. Chemotherapy works in conflict with the Gerson Therapy, which detoxifies the body in order
to restore the body's natural defenses. If a patient has undergone chemotherapy, he/she needs to wait
a minimum of 4 weeks after the last treatment to send his/her application. At that point, they need to
begin the Gerson Therapy at a modified level, so that they do not detoxify too quickly. For this reason,
we recommend that any patient pre-treated with chemotherapy begin the Gerson Therapy at a clinic, so
that they can be safely and gradually introduced to the therapy under a doctor's supervision.
•
I'm very interested in undergoing the Gerson Therapy, but I simply can't afford to go to a clinic. What other
options do I have?
The Gerson Therapy can be self-administered entirely from home, using the instructions in the
Home Package, the set of books and DVDs that contain the full instructions for the Gerson Therapy.
Ideally, a patient undergoing the Gerson Therapy from home would see a licensed Gerson practitioner,
but if there are no local Gerson doctors, it is best to follow up with a naturopath, or a doctor friendly to
and familiar with natural healing. A patient doing the therapy from home can also look into hiring a
certified caregiver or attending one of our Gerson Basics Workshops to learn the basics of the Gerson
Therapy so that they can practice it from home.
Page 12 of 12