Key Areas of Concerns

I hereby grant Katie Lynne Watkins, Holistic Herbalist and ARCB Certified Reflexologist, in the state of North Carolina, permission to act as an holistic herbalist and reflexologist on my behalf. I understand and hereby agree to my responsibilities as an active partner in the treatment process and to the fee structure as outlined. I realize that no guarantees have been given to me by Katie Lynne Watkins regarding cure or improvement of my condition. I understand that I am free to withdraw my consent and to discontinue participation in this process at any time.

I understand that a record will be maintained of my consultation with Katie Lynne Watkins. This record will be kept confidential and will not be released to others unless directed by myself or my representative or unless required by law. I understand that I may look at the consultation record at any time and can request a copy of it by paying an appropriate fee. I understand that my consultation record will be kept for a minimum of three, but no more than 10 years after the date of my first visit. I understand that information from my consultation record may be analyzed for research purposes, and that my identity will be protected and kept confidential. I give Katie Lynne Watkins permission to share information about my case and relevant materials with other relevant practitioners to ensure the highest quality of care.

I understand that Katie Lynne Watkins is not a medical doctor and that she will not offer a diagnosis for any medical conditions, nor will she offer treatment for medical conditions. I understand that my work with Katie Lynne Watkins does not constitute or take the place of attention by a medical doctor. I understand that she cannot diagnose or prescribe drugs and will not provide advice concerning the pharmaceuticals I have been prescribed or am considering taking. I understand that if I need advice concerning my medications or medical condition or illness, she will advise me to see a physician.

I understand that Holistic Herbalism and Reflexology do not replace a doctor. The practitioner will not prescribe or adjust medication. Holistic Herbalism and Reflexology are not a substitute for medical treatment, but may be a complement to most types of therapy. 

Happy Home Herbals is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, you can be assured that it will only be used in accordance with this privacy statement.

We will not intentionally share the contents of any email or information submitted via the internet with any third party. However, due to the nature of electronic communications, we cannot and do not provide any assurances that the contents of your email will not become known or accessible to third parties. We urge you not to provide any confidential information to us via electronic communication. Should you choose to communicate via email, the provider contacted will respond to any emails sent until you request that form of communication to cease. Please take all precautions necessary to secure your email should you choose to use it to contact the provider.

I understand that I am renting the time of the practitioner. I understand that not showing up for an appointment or without a minimum of 24 hours advance notice will result in a full consultation charge of $75 for a private appointment and $45 for a follow-up appointment. This charge must be paid before another appointment will be scheduled. I understand that payment is due at the time of my office visit by either cash, check or credit card.  I understand that a $35.00 service charge will be automatically charged for any returned checks, and that payment must be made in full before the next office visit.  I understand that once an herbal formula has been customized and made for me that I am repsonsible for the price of the formula and that payment for the herbal formula is nonrefundable. 

I hereby affirm that my electronic signature is my true and legal signature. I hereby affirm that the electronic signature is representative of the person who completed this form or the legal guardian of the person for whom this form was completed (for anyone under the age of 18 years of age).

I hereby affirm that my electronic signature is my true and legal signature. I hereby affirm that the electronic signature is representative of the person who completed this form or the legal guardian of the person for whom this form was completed (for anyone under the age of 18 years of age).