Northern Appalachia Clinic Disclosure Agreement

     Kaley (Calyx) Liddick is a qualified holistic health practitioner with over 12 years of clinical experience. She is an honors graduate of the Colorado School of Clinical Herbalism and the Aromatic Wisdom Institute, where she graduated with over 2,000 hours of training and clinical practice. Calyx is a Certified Clinical Herbalist, Certified Nutritionist, Certified Bach Flower Essence Practitioner, and Certified Aromatherapist. Calyx is not licensed or registered as a state health care professional, as there is currently no licensure in place for these modalities, and it is advised that any recommendations made should be discussed with the client’s primary care physician.

     Please take note that failure to disclose information regarding medical conditions, medications, supplements, allergies, etc. may result in conflict with herbal, nutrition, and lifestyle recommendations. We will not be held responsible for adverse effects or negative interactions due to the client’s withholding of any information during consultation or on our new client forms.

     By signing this document, you acknowledge that Kaley Liddick not licensed by the state of Pennsylvania and that her services do not replace those of licensed physician. All clients are advised to seek the advice of a licensed healthcare provider. Consultations are designed to provide education about nutrition, herbs, supplements, and lifestyle. Conventional medical diagnosis, prescription, and treatment cannot be provided during sessions. Herbal remedies sold by the Northern Appalachia School Apothecary are legally regulated as dietary supplements and should not be misconstrued as medical treatment or prescriptions.
     

     While prescription medications may be discussed during your appointment, only your prescribing physician can suggest that you discontinue or alter your medication. Any discussion or literature provided during your session is for educational purposes only and should be discussed with your prescribing physician.

     The goal of the initial appointment to is to gather information about your primary complaint and overall health in order to pinpoint areas of focus and create a personalized protocol designed to meet your unique needs. This is usually an extensive process; so we ask that you please allow the necessary time for us for the first appointment (generally around 2 hours, with time for a break as needed). Subsequent appointments generally require less time. In most cases it is recommended to start with at least two sessions in order to take full advantage of the process. The price of herbs dispensed vary and are not included in the price of the consultation.

     All session conversations and documentation are strictly confidential. Health related records cannot be released without your written consent, unless if legally subpoenaed. Exceptions to this are information regarding impending suicide, homicide, or child abuse. We cannot guarantee the security of correspondence via email or text message, however submissions through Jotform.com are HIPAA compliant.

     Northern Appalachia Clinic operates in accordance with the belief that healthcare is a human right and wellness services should be available and accessible to all. Services are available at a sliding scale. If you are unable to afford services, pleasre inquire about the by-donation clinic. 100% of payments received that exceed the suggested rate go to our People’s Folk Medicine Project fund and support by-donation clinic services.

     Refunds for consultation fees and custom herbal formulas are not available at this time. Our services are not eligible for insurance reimbursement. If you need to cancel your appointment, please contact us 24 hours in advance. If you are more than 15 minutes late to your appointment, the appointment may need to be rescheduled. No-shows will be charged a $45 fee. After three no-show appointments, the practitioner may discharge you.

Payments reflect the time spent in the appointment as well research and protocol write-up work completed outside of the appointment time.

Intake (new client) appointments include an initial consultation up to 2 hours and 15 minutes in length, plus a 15 minute follow-up protocol appointment.

Sliding scale: $175-215

Follow-up appointments are generally 30 minutes to 1 hour long.

Sliding scale: $70-115/hr

     We look forward to working with you!

I, the undersigned, have read and agree to the terms, and hold Kaley Liddick and the Northern Appalachia School LLC harmless for any injuries or negative effects I may experience as a result of using the information, therapies, or any other services I receive.