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Patient Consent Form I, ___________________________________________ consent to treatment by Zara Lashkova, DIHom, homeopathic practitioner at Homeopathy for Women (H4W). I understand that Ms. Lashkova is not a medical doctor and that homeopathy is not a medical specialty, but a separate and distinct health care modality. I understand that Ms. Lashkova has been professionally trained to be a homeopath, but she does not offer diagnoses, treatment or cure for any disease. Her practice encompasses consultations regarding natural remedies such as homeopathics. I understand that her assessments and recommendations are intended to assist me in using natural means to support my health and are not intended to serve as medical diagnosis or treatment. If I believe that I have a condition which requires medical care, I will consult my primary care physician or an appropriate specialist. I understand that Ms. Lashkova may, during her assessment, see evidence of a condition which should be diagnosed and treated by a medical physician or require laboratory or other testing to support good health care decision making, and in that event necessary referrals will be made. Ms. Lashkova is not my physician, certainly not my primary care physician, and I should understand that her work serves a supplemental purpose and I should not avoid any diagnostic work-ups or discontinue any medical treatment based upon my consultation with Ms. Lashkova. If I believe that modifications may be sensible in the light of natural approaches to care, I agree to first discuss such changes with my primary care medical physician and any related specialists. My homeopathic practitioner will explain her assessment to me and describe the nature of her recommendations, the expected prognosis without such care, and the anticipated costs, risks, benefits and experience of following various options. Negative reactions to homeopathy are extremely rare given the doses used (very high dilutions); an effective dose may result in a temporary increase in my symptoms or healing crisis. I understand that it is in my best interest to let my primary care physician know about my work with Ms. Lashkova to ensure my care is coordinated. I am aware that such consultations are an art and that no guarantees are made as to any outcomes. Some people may experience a healing crisis, a short period in which symptoms worsen or a period of a flu-like illness with mild fever, chills, dizziness, loss of appetite, or similar symptoms. Such an experience can signal the body detoxifying. The decision to seek homeopathic treatment is solely my decision and I understand that I may still seek the treatment of an allopathic doctor or any other health practitioner. Notice to Pregnant Women: All female clients must alert Ms. Lashkova if they know or suspect that they are pregnant as some of the remedies used could present a risk.
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