Please read, sign, and submit this online Homeopathic Treatment Consent Form at least 48 hours prior to your scheduled Initial Intake Appointment.

Homeopathic Treatment Consent Form

Evoke Homeopathy & Wellness
Homeopathy is a holistic and individualized alternative healing modality that addresses symptoms of disease through homeopathic remedies that encourage the body to self-heal. I understand that I should remain under the care of an allopathic physician while receiving homeopathic treatment.

I understand. I do not understand.
Homeopathic remedies can be taken concurrently with allopathic medications. If I am taking prescribed allopathic medications, I will remain under the care of my physician and follow his/her recommendations for medication dosing. I understand that Astaire does not have the authority to recommend changes in medication dosing. I understand that, during the process of homeopathic treatment, as my symptoms improve, it might become necessary to adjust medication dosing and this can only be done through my prescribing physician.

I understand. I do not understand.
I give permission for Astaire Roorda to share details of my symptoms with colleagues and/or a supervisor for the purpose of seeking advice and input, should this become necessary.

Yes, I give permission. No, I do not give permission.
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