Untitled Document

SF Comprehensive Intervention Program
Client/Parental Enrollment

The SF Comprehensive Intervention Program is a program in which complete dietary intervention and complete environmental intervention are implemented simultaneously. This is essential in order to so completely eliminate exposure to volatile organic compounds and moderately volatile organic compounds in foods, plastics, resins, indoor air, and molds that an abrupt, dramatic drop in symptoms will occur. The SF Comprehensive Intervention Program is not a program of partial change or of compromise, because with partial changes and compromises there is a high risk for developing new sensitivities to foods, for experiencing overall increasing symptoms in the long term, and because partial change and compromise does not end in recovery.

The SF Comprehensive Intervention Program is also a research program, and provides another reason that the recommendations of the program must be implemented fully. This is an open, non-blind study that documents the reduction in symptoms of the individuals entering the program. Consulting services are required, but are provided free throughout the program in exchange for participants allowing the data obtained to be used in the research program.

It is very difficult to obtain items for the environmental portion of the program that are pure enough. Because difficulties and problems encountered by others have delayed the children's progress, you will be required to purchase your materials from Special Foods, unless otherwise directed.

The signature to the form below indicates your understanding, acceptance of, and agreement to the following:

I (we) understand that the SF Comprehensive Intervention Program employs simultaneous complete dietary intervention and complete environmental intervention as a sole means of achieving impressive symptoms reductions in autistic children. I (we) understand that in addition to many food allergies and sensitivities, my child suffers (I suffer) from severe, extensive sensitivities to volatile and moderately volatile organic compounds in food, indoor air, plastics, resins and molds. I (we) understand that this is the underlying cause of my child's (my) problems, and that removing these substances will remove the associated symptoms.
I (we) understand that supplements are not a part of the SF Comprehensive Intervention Program, and agree not to use them during the program.
I (we) understand that professionals not part of and not familiar with the SF Comprehensive Intervention Program may suggest options that are not a part of this program; these include recommending low carbohydrate quantities, chelation, supplements and so forth. I (we) understand that I (we) will not be incorporating techniques such as these.
I (we) agree should a problem occur I (we) will contact the staff for guidance concerning how to solve the problem. There are many reasons for this and these have been explained to me.
I (we) understand that partial environmental changes will not achieve the impressive results achieved when complete environmental changes are made. I (we) understand that my child (I) must always stay in the only two initial environments that are acceptable, the special room and outside, until additional areas are modified and become acceptable. I understand that some leeway is available to less severely affected adults, and the staff will recommend an option appropriate for my situation.
I (we) agree that during the first 5 weeks of the SF Comprehensive Intervention Program, my child will not attend school unless the classroom has been converted into a clean room and procedures for the room, teachers, and educational materials are approved by the SF staff and agreed to be the school. I (we) further agree that my child will not return to school until all criteria of the program are complied with.
I (we) understand that my child's (my) specific symptoms, age, severity of his condition, the construction of the home we live in, it's age, it's heating and air conditioning system, and the time since renovation make my child's (my) circumstances unique. Therefore, although recommendations provided for me will be similar to those provided for other children (adults), they will not be identical. I (we) agree to fully implement all recommendations made for my child (me).
I (we) understand that my child (I) will be entering into the SF Comprehensive Intervention Research Program. I (we) give permission for data generated concerning my child (myself) and our progress during the program to be used in the research. I agree to provide a video record for use in the research program as well. I understand that our privacy will be respected and that all data will be protected as confidential data. I understand that case study reports that do not identify my child (me) will be prepared and published.
I (we) understand that weekly telephone counseling appointments are an essential part of the SF Comprehensive Intervention Program, and I agree to participate in these weekly appointments. I (we) understand that in return for participating in the above described research program, I (we) will not be charged for these appointments, nor for any other scientific and technical guidance and personal support provided. I (we) understand that home visits and reviews of home construction plans are not part of the research program, and there is a charge for these services.
I (we) agree to purchase materials for the dietary and environmental program from Special Foods, unless otherwise directed. I understand the reasons for this. I (we) agree to purchase a 5 week supply of foods for the Special Foods Diet immediately upon entry into the SF Comprehensive Intervention Program.
I (we) agree to fully comply with the conditions and requirements of the program.

I wish to enter ___ my child ___ myself into the SF Comprehensive Intervention Program. (check one or both)

Name: ________________________Address: _______________________________________

Telephone Number: ____________________ Birthday: ________________________________

I hereby agree to accept and follow the above described terms and conditions.

For adults:
Signature: ____________________________ Date:________________________________

For children: to be signed by both parents/guardians

Mothers Sig: __________________________ Date:________________________________

Fathers Sig: ___________________________ Date:________________________________