Practitioner - Client Agreement:
Nature of Work Performed by Practitioner: I understand that homeopathic practitioner, Rooksie David, evaluates my entire condition based on a holistic, homeopathic approach, and seeks to assist me in stimulating my body's own healing mechanisms with the use of substances prepared according to the guidelines of the Homeopathic Pharmacopoeia of the U.S, as regulated by the FDA. I understand that my practitioner, Rooksie David, may also discuss with me the use of other integrative therapeutics to improve my health, and that these are within her scope of practice to the extent that she incorporates them. I agree that I am interested in enhancing my own abilities to establish health in mind and body.
I understand that my practitioner is not a medical doctor and has not presented herself as such. She does not seek to diagnose, treat, or prescribe for disease, disorder, or other pathological conditions, and that she provides health consultation services.
Cost of Consultation: I have reviewed the fee statement below. I agree to pay these fees at the end of each consultation and follow-up. I understand that I can pay via PayPal when I receive a Columbia City Homeopathy email invoice, or I can pay by credit card. If I have an HSA/FSA debit card I may provide that card for payment at the time of service.
Professional Conduct and Consultation: Practitioner agrees to honor confidentiality and assures professional conduct as defined by the Code of Ethics of the Council for Homeopathic Certification. As a client I grant permission for my practitioner, Rooksie David, to discuss details of my health in conferral with professional colleagues without an additional confidentiality waiver. This agreement becomes part of my case records. As a client I agree to consult a licensed physician for any medical concerns that exists currently or arises at any time during the term of this agreement, and to inform my practitioner, Rooksie David of any physician's assessment or medical diagnosis for as long as I continue to work with her.
I agree to the office policies and charges as described in the fee statement.
Client Signature and Date:
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Practitioner Signature and Date:
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Fees and Policies for Consultation
Initial consultation (1 ½ -2 hrs.) $250
Therapeutic Focus Consult/Polarity Analysis consult (1 hr.) $175
Follow-up consultation (30 - 45 mins.) $125
Acute Care Consult (15 mins.) $45
Acute Care Consults are usually scheduled the same day and only for clients that have been seen within the past 12 months
Emergency Care - billed for time accrued in consultation with the client at an hourly rate of $125
Included in the fee for initial consults and follow-consults are brief check in calls/texts as required to track the response to a homeopathic remedy or other medicament or therapeutic. Any homeopathic remedies or supplements (herbs, gemmotherapy tinctures, cell salts, flower essences) are charged to the client if provided by Columbia City Homeopathy. Client can obtain most remedies and/or herbs, gemmotherapy tinctures, cell salts, flower essences independently from homeopathic pharmacies, Amazon.com, other online vendors or local health food stores.
Insurance / HSA / FSA: Columbia City Homeopathy can charge your HSA/FSA account at the time of service and will provide account statements that clients may submit to their insurance companies or FSA/HSA managers for reimbursement. Columbia City Homeopathy does not file any forms for insurance or reimbursement. Clients are encouraged to investigate all options for insurance reimbursement or use of plans such as Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA), which allow reimbursement of payment with pre-tax funds.
General Policies Regarding Scheduling and Client Support:
Scheduling and Cancellations: To schedule an initial consult or for a follow-up appointment please call or text 206-790-1475. All appointments are telehealth only. Appointments can be scheduled for Zoom meetings, WhatsApp video call or phone calls.
I understand that plans change, and unexpected circumstances arise that can disrupt your schedule, if it is necessary to reschedule or cancel an appointment, notification of schedule change must be made at least 24 hours in advance. I will work with you to move the appointment to a new time and date.
Appointments that are missed or cancelled late (less than 24 hrs. prior) represent time that was scheduled for the client, and this time is unlikely to be rebooked in a late cancellation or missed appointment. Each client is offered one “first miss” or late cancelation that is not charged. A second or later event will be charged at half the appointment fee.
Please note that I am never available to clients from 3pm PST Fridays - 9am PST Sundays. If you are in need of care or are experiencing a medical emergency during that time, please call 911 or head to your local emergency room.