General Policies
No-shows, or cancellations made less than 24 hours before the appointment, shall be billed at half the rate set for the appointment.
Payment is expected at the time of the consult and is billed through Square. Health maintenance debit accounts are accepted. Please make sure that you are in compliance with the guidelines and limitations for your account. .
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If you have an emergency situation, seek appropriate medical care first!
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For non-emergency, acute conditions, the best way to reach the homeopath is via email at blackbirdhomeopath@gmail.com, or leave a text or voicemail at (585) 260-4965.
On-call acute hours are M - Th, Noon to 1PM EST.
Adult Intake Forms
You can either complete these forms electronically and return them back to me via email, or print them, fill them out and scan them to return them to me.
NEW CHRONIC CLIENTS NEED TO COMPLETE AND RETURN FORMS #1 - 4.
1. Consultation
Agreement
For all incoming chronic consultation clients.
4. Consent For Treatment
Legal permission for you to receive homeopathic consultation.
Other Forms
Complete these forms if you are a parent having a child seen, or a pet owner with a pet to be seen by the homeopath.
5. Initial History: Infants & Children
This form covers gestational and birth issues, and early childhood development. Even if the client is an older child, please complete the infant form as best you can. Information about birth and early childhood can still be useful in cases involving older children.
6. Initial History: Animals
This is a health history form for new animal clients.
HIPAA Compliance Forms
In compliance with your rights under HIPAA, Blackbird Homeopathy requires your written consent to obtain or release information about your care. Please use these forms to allow Blackbird Homeopathy to obtain or release this information, and with whom.
HIPAA
Release
This form is a consent form used to allow the homeopath to share health information with other health practitioners.
HIPAA Release for Minors
This form is a consent form used to allow the homeopath to share health information about minor age clients with other health practitioners.
Request for Information
This is a release form allowing other health practitioners to share information with the homeopath.
Request for Info for Minors
This is a release form allowing other health practitioners to share information about a minor age client with the homeopath.