1. I hereby authorize Brooke Heather/Restorative Naturopathy and all representatives to act on my behalf concerning the corrective, therapeutic, natural, non-drug, non-evasive protocols offered to achieve health. I specifically authorize for my recommendations be based on holistic concepts and for nutritional and detoxification protocols, lifestyle, and environmental modifications.
2. I warrant that all information submitted for evaluation was submitted by me and is true to the best of my knowledge. I agree to inquire directly with us about any questions I may have on our evaluation tools/techniques before searching the internet or by acquiring other means of information for answers, as this can lead to a lot of un-necessary confusion.
3. I understand whole food nutritional advice is based on the Heart Sound Recorder and other techniques used for the practitioner to base recommendations on according to the training received in such.
4. I understand I am not attending an allopathic doctor (MD), but a wellness consultant; a Doctor in Alternative Medicine, a Certified Traditional Naturopath, Neurofeedback, Biofeedback and Digestive Health Specialist. The medical board to take up any issues with, should there be any, is with the First Nation Medical Board (“FNMB”) d/b/a Turtle Healing Band (authorized by agreement with Crow Nation to create a Tribal Health Care Program of indigenous medicine providers of the private THB members). I agree to the THB membership. Terms may be updated without notice.
5. I understand that I will not receive a diagnosis, allopathic drugs, surgery, chemical stimulants, or any other conventional treatments. I understand the programs recommended are in no way to take the place of traditional medical treatment and if I desire further information or services not provided, I will seek them elsewhere. Take note our willingness to work with other providers to implement a program of integrative wellness.
6. I consent to Wei Labs/Dr. Li and representatives to converse with in regards to my health in Wei’s recommendations of herbal products.
7. I understand quantum biofeedback is designed to reduce stress and pain naturally and non-evasively by enhancing the flow of energy throughout the body. I understand it is my responsibility to ask my medical doctor for permission to undergo biofeedback training if I wear a pacemaker or have any medical condition that may be exasperated by relaxation. The Biofeedback device is a Class ll medical device determined to be safe and non-invasive. It is used for reduction of pain and stress, improves sleep and mood/mental wellbeing.
8. The devise, nor the practitioner operates by diagnosing or prescribing, only a licensed allopathic physician can diagnose. I understand am not attending an allopathic doctor (M.D.). In addition, Brooke Heather, nor associates diagnose, treat, or prescribe for my disease or conditions, nor perform any act that constitutes in the practice of medicine for which a license is required.
9. Recommendations for other services/practitioners are only the advice of the practitioner I have consulted with and only to be followed if I believe it to be beneficial to my health and well-being.
10. I have solicited to this form of alternative healthcare and understand that services are not to substitute for standard medical, chiropractic, or psychotherapy treatment, nor veterinary care for my pet.
11. All information disclosed will be respected and kept confidential.
12. There will be a fee for returned checks.
13. There are no refunds for the services provided.
14. Full price plus a $20 fee may be charged for no-show appointments or cancelations the day of the scheduled appointment.
We consider it an honor and privilege to be of service to you and hope for a long and mutually satisfying relationship. We spend an inordinate amount of time and energy with each and every one of our new and established patients because we are committed to providing the highest quality care. Your appointment time is dedicated specifically to you. We do understand that there may be extenuating circumstances; however, we request that any cancellation or rescheduling of your appointment be made at least 24 hours in advance. We value your time and hope that you value ours. Missed appointments or appointments cancelled less than 24 hours in advance affect us all and prevent us from being able to serve others in need. Because of this, we have created a cancellation and missed appointment policy.
Payment prior to appointments is required. Fifty percent of session fee is retained for cancelations. Recurring no show shows may be charged full price or cancelations the day of the scheduled appointment.
There are no refunds for the services provided.
Bills past due by 30 days accrue charges as follows: A one-time inconvenience fee of $10 and $10 per month past due will be owed.
Note that any courtesy discounts may also be reversed due to delinquency.
Clarifications Regarding Given Discounts:
In the case of discounts given, the condition is that there be the fulfilment of the amount of recommended consecutive appointments (with the exception of the occasional need to reschedule). If the agreement fails to be fulfilled Restorative naturopathy reserves the right to bill for the difference in fees to recoup the finical loss in the specified term of the agreement. For example, one may want to receive the package pricing to receive a lower cost per appointment but cannot pay the package fee in full. A payment plan may be implemented, in which case would result in the special pricing (lower than the regular fee of $120 per hour). If only half the amount of appointments were fulfilled at a discount, the remaining difference may be owed.
Phone/ Email Support:
Phone/ email support is included for you during the first month of chronic treatment or the first week after an acute visit. This is intended to aid in answering any questions or concerns that may arise or to clarify instructions. This is not intended to take the place of an office visit. Phone consultations/ emails that cover new material, require new information, or take more than fifteen minutes are essentially substitutes for office visits and require the same time and expertise as office visits. These will be billed at a minimum of $45.00, and may be billed at the same rate as the visit for which they substitute. For example, a detailed call that substitutes for a limited visit will be billed at $90-$120.