Adult Consent Form
I acknowledge that I have the option of seeking/continuing conventional medical care from a medical doctor and that homeopathic treatment and conventional medical treatments are different but can complement each other. I confirm that there has been no suggestion made to me that I refrain from seeking or following conventional medical treatment. I recognize that input from my medical doctor is welcome, and the information will be used to augment the homeopathic case-taking process. I am free to withdraw my consent and to discontinue treatment at any time.
I confirm that any prescription medications I am taking under the care of a physician will not be withdrawn without his/her supervision. I fully understand what has been presented to me with regards to the nature of homeopathic medicines and their safety, and the credentials of my homeopath.
I understand that a block of time has been set aside for my private appointment and that a 24-hour notification is required if I must cancel for any reason. I understand that there is a full charge for appointments cancelled less than 24 hours in advance. I understand that payment is due at the time services are rendered. I understand that the current fees for consultations are as follows but that there may be changes to the fee structure in the future.
Initial Consultation: $300 Follow-up Consultation: $100 Remedies: $15 Acute Consultations is $70 + HST
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