Disclosure and Inform Form
This form is being given to you to provide information regarding our client/practitioner relationship and to also outline my ethical practices as an herbalist. After reading this you will then be able to make an informed decision as to whether you would like to consult with me regarding your health concerns, and what you personally would like to gain from working together.
The Role of the Herbalist
As an Herbalist, my ultimate goal is to educate and empower you to reach your health goals. To do so we will approach our sessions from a nutritional, lifestyle and Herbal perspective, which is essential to “adaptive” health. My belief is that our body is innately capable of healing itself and with an individualized herbal lifestyle protocol that is properly used; the body can then be supported to return to a healthy, balanced state.
I do not diagnose or directly treat disease. I do however focus on educating you, the client, on how you can personally enhance your body’s own innate healing capacity. All client records are confidential and will only be discussed with you unless you specifically request otherwise. I will be glad to share with you any questions or concerns you may have regarding my training, credentials and experience. If I feel that your needs and wishes are beyond my training and expertise I will gladly refer you to another practitioner. I encourage and support any additional consultations you may wish to pursue especially in the diagnosis and treatment of your health condition.
Client Rights and Responsibilities
-Payment is due at the time services are rendered-Fee: Initial Consultation $150 for a 1-hour and 45 minutes to 2 hour session; Follow up $30 per 30 minutes. Only checks or cash accepted-Missed Appointments: except for emergency situation, without 24 hour notice you will be charged a $50 fee-Formulas and suggested products: These can be purchased through me directly, however please note you are not obligated to do so and may purchase all or any products elsewhere.
You have the right to courteous and respectful care. At any time you may choose to no longer follow any or all of the recommendations provided to you as a result of this consultation. You have the right to consult with another practitioner and all records will be provided upon written request.
Herb Safety
As with anything one takes for their health, they must educate themselves. Throughout history and even through modern research, most herbs that are used for healthcare have excellent safety reports. Herb and drug interactions are rare, but possible. Herbs should not be taken during pregnancy or lactation without expert advice. If you should become pregnant while taking herbs, stop taking them until you have seeked out professional advice. For your safety, it is also your responsibility to fully disclose any medications, herbs, and/or supplements you are currently taking so that you can be offered informed advice. Any suggestion that the effect of a drug is being altered by simultaneous use of an herb should be reported to all health professional involved.
If you are scheduled to have surgery or have been prescribed anticoagulatnts, antiepileptic drugs and/or digoxin, it is advisable to stop taking all herbs and supplements at least 72 hours prior.