Forms and Documents....
The following PDF (Portable Document Format) forms/documents are required for the consultation and need to be completed prior to the first session. Tables below shows the documents under the heading "Form/Documents Name" which are linked to the files and a brief description of what needs to be done for each form in column labeled as "Description". Please download all required documents.
The following Documents are required for ALL ADULTS (16 years and older):
Form/Document Name |
Description |
| Preparing for Homeopathic Consultation | This is for you to keep and read before the consultation. It points out what we are looking for when we have the interview. |
| Homeopath-Patient Services Agreement (Consent to Treatment) | This is for you to keep and read, except Pages 1 and 12 of this form should be signed and turned in. You can read this on line if you choose and hard copies can be provided to you at the time of our meeting to sign. (Note: The blank page at the beginning and end of document is for double sided printing). |
| Registration Form | This form should be filled in on all pages completely and returned prior to the consultation. Please do not rush through this form. It is an important document in the homeopathic process. NOTE: You can use the electronic Fill-able form available from link below. |
| Consent form for sharing patient information with supervisor | Please sign and bring it to the first meeting. This is required so I can share the case info with my supervisor if needed. |
| Video taping | Please read and sign in either at the two locations or only the second part. This is required. |
The following Documents are required for ALL CHILDREN (Newborn to 15 years old):
Form/Document Name |
Description |
| Preparing for Homeopathic Consultation | This is for you to keep and read before the consultation. It points out what we are looking for when we have the interview. |
| Homeopath-Patient Services Agreement (Consent to Treatment) | This is for you to keep and read, except Pages 1 and 12 of this form should be signed and turned in. You can read this on line if you choose and hard copies can be provided to you at the time of our meeting to sign. (Note: The blank page at the beginning and end of document is for double sided printing). |
| Registration Form | This form should be filled in on all pages completely and returned prior to the consultation. Please do not rush through this form. It is an important document in the homeopathic process. NOTE: You can use the electronic Fill-able form available from link below. |
| Consent form for sharing patient information with supervisor | Please sign and bring it to the first meeting. This is required so I can share the case info with my supervisor if needed. |
| Consent form to Treat a child | Please sign and bring it to the first meeting. It is required to obtain permission in order to treat a minor. |
| Video taping | Please read and sign in either at the two locations or only the second part. This is required. |
NOTE: You must have Acrobat PDF reader or a similar application in order to be able to open and print these files. Please click on the Adobe logo to download Adobe Reader. Please ensure to download the correct version for your system, i.e. either Mac or PC version.
Registration Form-Electronic Fill-able form. Please click on the link and down load the file. Please note that if you use Acrobat reader you can only print after the file is filled out. If you have a full Acrobat Application then you are able to save the file and email it to Active Homeopathy.