Informed Consent for Clinical Services
The purpose of this form is to outline the responsibilities of the client and the practitioner as we enter into a healing partnership. It is to foster clarity about the client/practitioner relationship and to outline the standards of practice of an herbal consultant. Our hope is that with this information, you can make an informed choice about whether or not you wish to consult, and if so, what you want to learn and achieve through your work with an herbalist at the Railyard Apothecary.
The Role of the Herbalist Practitioner
We believe that the herbalist’s primary role is as an educator and partner, encouraging and supporting your goals for improving health and well-being. Herbalists neither diagnose nor treat disease. Rather, we focus on educating you, the client, on how to best enhance your body’s innate healing capacity. Our intent is to help you achieve the highest state of health consistent with your own goals and in collaboration with your broader health team. Herbal practice is based on the belief that the human body is a resilient and intelligent system that is innately self-healing and that properly crafted herbal formulas assist and encourage the body in its effort to return to a healthy state. Every person is physiologically, emotionally, and energetically unique. We will consider your individual constitution and nature and recommend the most appropriate herbal, dietary, and lifestyle changes specifically for you.
Client Role, Rights and Responsibilities
Your role, as the client, is the most important factor in working towards health goals. It is important for you to identify personal goals in order to move towards living life fully and optimizing health. Doing this means understanding what matters to you and looking at all aspects in life that contribute to a sense of well-being.
All client records are confidential. We may discuss the details of you case with professional herbal colleagues for the purpose of providing you with more effective and safe recommendations. This will always be done in such a way to avoid giving any personal information that might reveal your identity. Aside from these communications, we will hold in strict confidence all information gathered from and discussed with you, unless you specifically request otherwise.
We will gladly answer any questions regarding practitioner training, credentials, and scope of practice. If we feel that your needs and desires are beyond the scope of herbal practice or personal expertise, you will be referred to another practitioner. We support and encourage your right to consult any practitioner of your choice, especially in the diagnosis and treatment of disease.
Payment is due at the time of services.
Except in emergency situations, we request that you give no less than 48 hours notice in the event that you need to cancel an appointment.
Herbal Consultation Informed Consent
In the spirit of Nature’s diversity, all individuals, regardless of race, color, religious or spiritual belief, cultural background, sexual orientation, or gender identification are welcome and encouraged to receive services. You can, and should, expect a respectful, courteous, and caring experience. We welcome any feedback you may have regarding any and all aspects of your experience working with us.
You are free to refuse to follow any of the recommendations provided as a result of your consultation and/or to choose to discontinue the client/practitioner relationship, however we appreciate you making us aware of this decision.
Side Effects, Toxicity, and Herb-Drug Interactions
Historical evidence and modern research indicate that the most commonly used herbs have an exceptional safety record. Similarly, confirmed cases of herb and drug interactions are rare. However, adverse events can occur after using any active substance. We will not suggest that clients ingest plant doses known to have toxic effects. The organs that are most vulnerable to any potent substances are the liver and kidneys, and it is important for you to divulge any previous history of disease in either of these organs so that we can provide you with information suitable to your circumstances. Herbs also should not be used in pregnancy or lactation without expert advice, and if you become pregnant you should stop taking herbs until advice is received either from us or another knowledgeable professional.
It is also your responsibility to fully disclose any medications currently in use, including other herbs and supplements, so that you can be offered informed advice. It is also recommended that you inform your doctor of all herbal and nutritional supplements you are taking. Any suggestion that the effect of a drug is being altered by simultaneous use of an herb should be reported directly to all health professionals involved. It is also advisable to stop taking herbs at least 48 hours before a surgical operation, and in the event of being prescribed anticoagulants, anti-epileptic drugs, and digoxin.
By writing my and checking the box below I acknowledge that I have read this document and I understand the nature and
extent of the client and practitioner relationship. I hereby voluntarily consent to an herbal consultation.
I understand that I am free to discontinue service at any time. I understand that my practitioner is not a licensed physician and therefore cannot diagnose or treat disease, or prescribe drugs. I understand that an herbal consultation is not a substitute for regular medical care, but can offer guidance and information so that I may better understand and heal myself.
I acknowledge that all the declarations on this form are truthful, including the name that is recorded below, and that I have read the information herein contained and had an opportunity to ask questions and have them answered to my satisfaction.
Yes, I give my acknowledgement
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