Integrative Health Consent & Billing Agreement

Scope of Integrative Health Services

Integrative health consultations are provided by a licensed pharmacist for wellness and educational purposes. These services do not replace medical diagnosis, emergency care, or treatment by a physician.

Complete Follow-Up Consultation - $275 Additional Consultations & Communication - $150/hour ($50 minimum for calls, texts, or emails)

This is a cash-based practice. Insurance is not billed. Payment is due at the time of service. Labs and supplements are not included unless stated.

I understand the scope, limitations, and financial responsibility for integrative health services.

Initial Integrative Health Intake Form

Patient Information

Reason for Visit

Medical History (Brief)

Lifestyle Overview

I consent to integrative health services.