Disclaimer
Disclaimer/ Consent form Content: One for adult, one for minor (Minor may not be mandatory)
Kavita Doshi has been practicing since 2023. She is registered with The North American Society of Homeopaths RSHOM(NA). She has agreed to abide by the code of ethics of each of these organizations. Homeopathy views health and illness in a holistic manner and this view is different from the standard, conventional approach which usually limits its concerns to individual symptoms. In working with the whole person, the homeopath regards the mental and emotional as well as physical aspects as important. A minor aggravation or worsening of some symptoms may occur as a part of the general healing process.
Confidentiality I understand that all information disclosed is confidential and may not be revealed to anyone without written permission, except where disclosure is required by law. Disclosure may be required in the following circumstances: a reasonable suspicion of child or elder abuse: a reasonable suspicion that a client presents a danger to him or herself or others.
Consultation I am 18 years of age or older and voluntarily chosen homeopathic treatment for myself. I understand that Kavita Doshi is a homeopath and not a medical doctor, it is therefore recommended that I retain the services of a primary care physician for appropriate evaluations and check-ups for myself. I further understand that Kavita Doshi does not diagnose, treat or prescribe for any particular symptoms, disease or condition. I understand that she will increase my general vitality and constitutional strength.
Client Agreement Form
By signing this agreement, I acknowledge that Kavita Doshi (Service Provider) practices Classical Homeopathy and holds a BHMS degree from Chandaben Mohanbhai Patel Homeopathic college in India, which is accredited by the Mumbai Council of Homeopathy. The Service Provider has over 20 years of experience.
I understand that the Service Provider is not a licensed physician in California but provides services under Sections 2053.5 and 2053.6 of California's Business and Professions Code, complying with specific requirements and restrictions. The services offered include interviews, information analysis, homeopathic remedy recommendations, and follow-up consultations. These services are considered alternative or complementary to licensed healing arts services and are not a substitute for medical supervision or advice.
I acknowledge that I am seeking alternative therapy for overall mental, emotional, and physical well-being, including lifestyle, educational, nutritional, and homeopathic advice or recommendations. I understand that the Service Provider does not diagnose or treat specific medical or psychological conditions, and I must consult a physician for such matters. I am aware that the outcome of homeopathic advice may vary for each individual and is not guaranteed.
I understand and confirm that the services provided by the Service Provider are not intended to diagnose, mitigate, prescribe, treat, cure, or prevent any disease, illness, or symptoms as defined by the FDA and the State of California. The Service Provider does not treat, prevent, or mitigate adverse events associated with disease therapies.
I hereby release the Service Provider from any liability and hold them harmless from any damages or losses that may occur during our association. I assume all risks associated with personal injury or damages that may result from my association with the Service Provider. I agree to indemnify and hold the Service Provider harmless from any claims, damages, costs, or liabilities, including attorney's fees and costs, related to the homeopathic remedies and/or recommendations I (or my child) receive.