Consultation Agreement
  1. Nature of work performed:

    I understand that Sima is a certified homeopathic consultant, certified CEASE practitioner, GAPS certified practitioner and nutritionist who evaluates my entire condition based on homeopathic approach, and seeks to assist me to stimulate my body’s own healing mechanism with the use of homeopathic medications, supplements and nutrition appropriate for my health complaints. I understand that she is not a medical doctor, has not presented herself as such, and does not seek to diagnose, treat, or prescribe for disease, disorder or other pathological conditions. I understand that Sima Ash may also discuss with me the use of other complementary alternative medicine 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 agree to consult a licensed physician for any medical concern that now exists or arises at any time during the term of this agreement, and to inform Sima Ash of my physician’s assessment in so far as it applies to my homeopathic case.

    Cost of Consultation:
    I agree to pay $550 for initial consult and $175 for follow up consultations which are scheduled every two months. These payments may be paid in cash, by check or credit card. Your initial consultation will take up to 2 hours. If additional time is needed, the fee for each 30 minutes will be prorated.

    For International Patients: I agree to pay $650 for initial consult and $250 for follow up consultations. Your initial consultation will take up to 2 hours. If additional time is needed, the fee for each 30 minutes will be prorated.

    Rights and Responsibilities:
    Sima Ash agrees to honor confidentiality and assures professional conduct as defined by the code of ethics of the North American Society of Homeopaths and the Council for Homeopathic Certification. Sima also agrees to elicit a history of indications relevant to my condition, discuss with me accordingly, and guide my selection and use of homeopathic medications in accordance with the principles of homeopathy. I retain the services of Sima Ash as a homeopath, and in order to maximize the benefits received from this work, I agree to provide a summary of medical and non-medical health care services which I have sought or am now considering, along with a complete description of my health history and current conditions. I also agree to provide accurate feedback about the results of homeopathic medicines I take and other complementary actions that I pursue. This agreement becomes part of my homeopathic case records. Sima Ash and Healing 4 Soul have the right to terminate treatment at any time.
  2. Name(*)
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  3. I Agree
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  4. Date

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  5. Email Address(*)
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  6. Verification(*)
    Verification
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