1. Purpose & Scope
These services provide complementary wellness education and traditional herbal support and are not a substitute for medical or regulated health-care services. I am not a medical doctor, physician, nurse, pharmacist, or other regulated medical practitioner. I do not diagnose disease, provide emergency care, or prescribe pharmaceutical medication. I will not instruct you to start, stop, reduce, replace, or change prescribed medication. Consult your physician or pharmacist regarding medications.
2. Services
Consultations may include review of voluntarily provided health history, symptoms, lifestyle, diet, medications and supplements, followed by individualized wellness recommendations involving herbal tinctures, teas/infusions, powders or other herbal preparations, nutrition, lifestyle and general wellness education. Discussion of symptoms or physiological processes is educational and does not constitute a medical diagnosis.
3. Herbal Risks & Limitations
Herbs are biologically active and are not risk-free. Possible risks include allergy or intolerance, gastrointestinal upset, dizziness, sedation or stimulation, changes in blood pressure or blood sugar, bleeding effects, hormonal/menstrual effects, pregnancy-related risks, and drug-herb or supplement-herb interactions. Individual responses vary and outcomes cannot be guaranteed.
4. Client Responsibility & Medical Referral
I agree to provide complete and accurate information about my health, medications, supplements, allergies, pregnancy status and other relevant circumstances. I understand that I may accept or decline recommendations and will use herbal products only as directed. I will stop use and seek appropriate professional advice if I experience a concerning or unexpected reaction. I will inform my physician/pharmacist about herbs and supplements I use. I will seek medical/emergency care for severe, unusual, rapidly worsening or potentially life-threatening symptoms. The practitioner may recommend medical assessment when a matter falls outside the scope of a wellness/herbal consultation.
5. Liability & Acknowledgement
I accept responsibility for decisions I make regarding recommendations I choose to follow and for my use or misuse of herbal products. I understand that the practitioner and practice are not responsible for consequences arising from inaccurate or incomplete information I provide, failure to disclose relevant information, failure to follow directions, misuse of products, failure to obtain appropriate medical care, or adverse reactions that could not reasonably have been identified from the information available at the consultation. I, the undersigned, understand that I am responsible for the health decisions I make and voluntarily agree to assume responsibility for my actions and use of herbal products and release Rooted Traditions, Leaf and Medicine and Radha Krishna Singh from all responsibility for my actions and any consequences thereof in the present time and in the future with no constraints.
6. Fees
Adult Initial Consultation (1 hour): $60. Follow-Up (30 min): $30. Herbal preparations / products based on herbs: $30 to $60. Payment: Cash or Email Transfer: rtlmherbalist@gmail.com.
Consent
By signing, I confirm that I have read and understood this agreement, had an opportunity to ask questions and received satisfactory answers. I understand the scope and limitations of the services, potential herbal risks, my responsibility to provide accurate information, and the need to seek appropriate medical care when necessary. I voluntarily consent to Rooted Traditions, Leaf and Medicine providing wellness and traditional herbal services.
Your typed name and date above will be included as your signature in the completed intake PDF.