CAERS Patient Medical Records Consent Form

The following form is for CAERS patients to provide your  permission to transfer your Medical and Personal Records from CAERS to CC TeleHealth (CCTH).

All information will be transferred with secure encryption and kept confidential as part of the CC TeleHealth Electronic Medical Records (EMR) system.

Once you have completed this form, you will be taken to another page to register for vaccine injury treatment.

FEES: $299 (normally $599) + $50 CCTH Membership Fee (Designed for patients who would like a broader range of treatment to track results and adjust treatment according to patient progress during treatment.)
NOTE: Treatment price increase to $799 on July 1, 2022.

The first phase of treatment is customized to your needs and provides progressive feedback on whether the commonly effective treatments work for you. This package of services includes:

Health Assessment
  • Completion of a series of assessment forms by patient (nutritional, metabolic, health history, diet etc);
  • Review of forms by a Health Care Provider (HCP) to develop an appropriate plan of action for patient;
  • Identification of critical care that may be urgently needed, along with a referral for treatment if necessary.
  • Three appointments with a HCP, provided over a period of 3-6 months;
  • HCP visits are designed to provide and adjust treatments based on how a patient is responding to treatments;
  • Response to treatments in phase one provide a road-map on what may be required for phase two.
Registered Nurse (RN) Support Activities
  • Two or three visits with a Registered Nurse to monitor progress and provide health care support;
  • RN visits are to identify changes, and provide guidance in patient activities that support the healing process;
  • Providing feedback, support and answers to health questions.
Participation Within a Support Community (optional)
  • Access to support group activities (6 weeks), providing guidance and support with respect to adjusting lifestyle activities to better cope with COVID-19 Vaccine Injury;
  • A  support community that reduces the stress and loneliness experienced from the isolation due to Vaccine Injury:  provides a place to talk with others who are in a similar situation;
  • A Guided Community: the activities and topics covered in the support community are designed to enhance lifestyle practices that affect the healing process. Areas addressed in the Guided Community are:
    • skills for belonging and connecting within a community. (Support community is facilitated by practice experts, including guidance on how to participate in a community in a manner that encourages and strengthens each patient’s coping abilities.);
    • relatinoships:
      • relationships with family and friends
      • relationships with the medical system
      • relationship with yourself
    • intermittent fasting;
    • sleep;
    • food;
    • dealing with stress and fear;
    • building your support community;
    • managing and tracking symptoms;
    • mourning the loss caused by health challenges.

Treatment package includes a book called, Covid Vaccine Adverse Reaction Survival Guide, by Caroline Pover.

Financial Details
  • Initial payment: $100 to schedule appointment ($50 membership + $50 deposit towards the balance of your appointment fee). 
  • Balance due after your first appointment.