Thank you for your interest. Please read and sign the Informed Consent below and as soon as we receive your agreement to our consent, we will contact you to discuss your inquiry, or our services, programs, upcoming events.
- I hereby authorize Well Space, Restorative Naturopathy, Heather Holistics and all associated 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.
- 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.
- 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.
- I understand I am not attending an allopathic doctor (MD), but a wellness consultant aa Doctor in Alternative Medicine, a Certified Traditional Naturopath, Holistic Heath Practitioner 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.
- 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 any other provider(s) to implement a program of integrative wellness.
- I consent to Wei Labs/Dr. Li and representatives to converse with Heather Holistics LLC in regard to my health in Wei’s recommendations of herbal products.
- 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.
- 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 does not 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.
- 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.
- 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.
- All information disclosed will be respected and kept confidential.
- There will be a fee for returned checks.
- A $20 or 20% of set visit fee may be charged for no-show appointments or cancelations the day of the scheduled appointment.
- We do not bill insurance but do provide invoices. There are no refunds for the services provided.
- I acknowledge that I have read and understand all parts of this form and release Brooke Heather and all associates from liability. I have had the opportunity to ask any questions with regard to the described procedures and hereby affirm: I am not here for allopathic medical diagnosis or treatment. I confirm my voluntary participation in services. Furthermore, I believe holistic care to be beneficial to my health/my child’s health.