New Client/Student Release, Fees & Working Agreement RELEASE & GENERAL POLICIES REGARDING FEES, PAYMENT, AND SCHEDULING NATURE OF WORK PERFORMED BY CONSULTANT I understand that my consultant evaluates my entire condition based on a holistic, homeopathic approach, and seeks to educate me about holistic nourishment, the GAPs™ diet and homeopathy remedies which are prepared according to the guidelines of the homeopathic pharmacopoeia of the USA, as regulated by the FDA. I understand that if I choose to use them, that they may stimulate my body's own healing mechanisms. I understand that my consultant may also discuss with me the use of other integrative therapeutics to improve my health, and that these are within her scope of expertise as an educator to the extent that she incorporates them. I agree that I am interested in increasing my knowledge of these modalities and to use them to enhance my self-healing abilities in mind and bodyst Choice TRAINING AND CREDENTIALS OF CONSULTANT I have reviewed the training and credentials of the wellness coach (herein referred to as "coach") listed below. I understand that my wellness coach is not a medical doctor, has not presented herself as such, and does not seek to diagnose, treat, or prescribe for disease, disorder or other pathological conditions, and that she is providing an informational wellness consultation. During our consultation, I may choose to prepare my own Personal Formula from the Bach Flower Essences Kit of the coach. I I do so fully aware that the ingredients come from my coach's supply of remedies and fresh and unopened spring water. I accept this bottle as my own preparation and will hold my coach; Lise Battaglia completely harmless if the remedy goes sour or gets cloudy. I have been given the document "Taking your remedy”. I am aware that I may purchase the remedies separately and prepare my personal formula using those at my own cost, or I may purchase my personal formula from the Alchemist's Apothecary, rather than use my coach's collection of essences. LISE M. BATTAGLIA CCH, BFRP, HMC, C.GP, C.HP. Lise Battaglia her BA at Barnard College, Columbia University in 1984. She completed 3 year culinary education in Florence, Italy in 1990 She is certified as a Bach Flower Registered Practitioner, educated by the Bach Center, USA., 1996 She completed a 2-year certificate program at the New York School of Homeopathy in NYC completed in 2007. She completed the 3-year program: Homeopathic Master Clinician: Luminos Homeopathy Courses, Minnesota, 2011 She has completed over 1000 additional hours in clinical training and supervision as a constitutional homeopath. She is a Certified GAPS™ Practitioner, trained by Dr. Natasha Campbell McBride, 2013. She is a Certified Homeoprophylaxis Supervisor, 2013. She is certified as a Constitutional Homeopath, by the Council for Homeopathic Certification, 2014. COST OF CONSULTATION I have reviewed the fee statement below. I agree to pay these fees at the time that services are provided, by cash, check or credit card to Lise Battaglia Wellness, LLC. I agree to the office policies and charges as described below.. PROFESSIONAL CONDUCT AND CONSULTATION Coach agrees to honor your confidentiality and assures professional conduct as defined by the Code of Ethics of the Council for Homeopathic Certification; Client grants permission for my coach to discuss details of my health, conferring with colleagues and other practitioners without additional confidentiality waiver. This agreement becomes part of client's case records. Client agrees to consult a licensed physician for any medical concern that now exists or arises at any time during the term of this agreement, and to inform my practitioner of my physician's assessment as far as it applies to my work with her. Payment The client is responsible for payment of all fees at time of service. Payment may be made with cash, check, credit card (AmEx, Visa, MasterCard, Discover) or PayPal. Clients who have off-site consultations are asked to keep a credit card on file with the office to simplify payment. A $40 fee will be charged for any check returned to this office unpaid. Questions & 1st time mini consultation. 15 min , no cost Initial Consultation 2 hours 2 hours $160 One Time, New Client Research Fee $75 Therapeutic Focus: Integrative coaching : GAPS, Bach, Homeopathy, Recovery Counselling 1 hour $80 Therapeutic Focus : 30 minutes After hours calls made to cell phone emergency fee added to service fee 15 min $20 Insurance / HSA / FSA This office will provide account statements which clients may submit to their insurance agency or FSA/HSA managers for reimbursement. This office does not file any forms for insurance or reimbursement. Clients are encouraged to investigate all options for insurance reimbursement or use of plans such as Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) which allow reimbursement of payment with pre-tax funds. Cancellations If it is necessary to cancel / reschedule an appointment, notification of schedule change must be made at least 24 hours in advance; appointments that are missed or cancelled late represent time that was scheduled for the client, and will be charged the full fee. Interim Support For scheduling, brief check-ins and acute complaints, please call during midday call-in time. There is no charge for calls during this time. These are intended to be brief calls that can be taken care of in 5 minutes or so; if an acute appointment (usually 15 minutes) is required, it can often be scheduled later that day. Call in time for Lise Battaglia, CCH, BFRP, HMC, C.GP, C.HP : 12:30pm-1:00pm EST, Monday – Friday each week. Clients with urgent questions may call Lise’s cell phone 908.528.0556; there is always an additional fee for an urgent call to this cell phone. If you have a life-threatening emergency, call an ambulance, 911 or get to an emergency room immediately. Email Clients can email the office for scheduling, questions and other non-urgent topic at info@HomeopathyHealingArts.com. Calls are generally answered each day, emails are answered as time allows, which can be delayed during times of travel or high volume of email. If there is any concern that requires prompt response, or you have not gotten a reply from an email in the time frame they require, please call. Telehealth – Off-Site Consultation Via internet or telephone. First appointments must be face to face. Please place a checkmark next to each paragraph, indicating that you have read the accept the terms of that paragraph.SignaturePlease sign this form to indicate that you accept the terms and provisions.