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California Health Freedom Act Disclosure
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Disclosure Form (PDF) California Health Freedom Act Disclosure Homeopathy is considered an alternative therapy and is not a substitution for medical treatment. The information and therapy offered by KARI J. KINDEM, HOMEOPATHY FOR WOMEN for her homeopathic services does not include a diagnosis. Homeopathic remedies are available over the counter and are FDA approved. 1) In compliance with Section 2053.6 of Senate Bill SB577, KARI J. KINDEM, HOMEOPATHY FOR WOMEN, discloses the following: a) That she is not a licensed physician. b) That the treatment is alternative or complementary to healing arts services licensed by the state. c) That the service to be provided is not licensed by the state. d) That the nature of the service to be provided is Homeopathy. e) That the theory of treatment upon which this service is based is the Science of Homeopathy, practiced in accordance with the advanced methods of the Fifth and Sixth Editions of Samuel Hahnemann’s Organon of Medicine. f) Education, Training, and Professional Experience Schools – Caduceus Institute of Classical Homeopathy. Current enrollment toward certification as Certified Classical Homeopath (CCH). Acute Homeopathics Certificate of Completion for the 50 hours professional course. Homeopathic Studies - Renaissance Institute of Classical Homeopathy (R.I.C.H.) Professional Affiliations – Member, The National Center for Homeopathy
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- Kent, Boenninghausen, Hering I hereby accept full responsibility for any actions taken by myself and/or my child(ren) concerning any foods, homeopathic remedies, herbs, supplements, exercises, and educational therapies with KARI J. KINDEM, HOMEOPATHY FOR WOMEN. I hereby release the above named from any liability resulting in any possible damages or loss during our association. I understand that rather than medical advice or treatment, I am seeking alternative treatment in the form of lifestyle, educational, nutritional, and homeopathic advice and/or recommendations. Under no circumstances, should any suggestions be taken as a diagnosis or direction against a licensed physical or mental care professional. I affirm that I am seeking self-help advice in natural health or educational matters only, and if I desire a diagnosis or treatment for any medical condition, I must consult a physician. I acknowledge that KARI J. KINDEM, HOMEOPATHY FOR WOMEN is not a medical institution, medical doctor or licensed practitioner. I acknowledge that I have read and understand all that is disclosed here. Signature ________________________________________________________ Date ______________________ Printed Name _____________________________________________________ Signature ________________________________________________________ Date ______________________ Printed Name ______________________________________________________ Child(ren)’s Name (s) ________________________________________________
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