Adult Intake Form

Sonya McLeod uses non-invasive methods for the assessment of bodily dysfunction, and homeopathy for their correction. In order to avoid any confusion or misunderstanding, she requests that all clients read and acknowledge the following: •That you understand that Sonya McLeod works within the homeopathic scope of practice, is not a medical doctor, and employs some methods which are not orthodox medical practice at this time. •That you understand that care here and/or referral to other health professionals is based upon the assessment revealed through personal history and interview, physical assessment, and laboratory testing. •That you understand homeopathic care is not generally covered under MSP at the present time and, therefore, you are responsible for any fees incurred while under treatment. Homeopathic care is covered under many private insurance plans and appropriate documentation will be provided to your insurer upon request. •That you are here as a client and are not attending this clinic for any other reason without making your intention known. Please be informed that you are required to give at least 1 business day notice in case you need to cancel or reschedule any appointment, including the initial one. Otherwise you will be charged for the missed appointment. I greatly appreciate your consideration in this matter.

Sonya McLeod will take a thorough case history. It is very important that you inform Sonya of any disease process that you are suffering from and any supplements/medications/over the counter drugs that you are currently taking. Please advise immediately if you suspect you are pregnant, or if breast-feeding. There are some health risks associated with the use of homeopathic remedies, herbs and supplements. These include but are not limited to the following: • Homeopathic remedies may occasionally result in the aggravation of pre-existing symptoms. When this occurs, the duration is usually short. • Homeopathic remedies may stimulate healing or detoxification reactions, which may include loose stools, increased perspiration, skin eruptions and nasal discharges, among others. These reactions are relatively uncommon and normally pass within a few hours to days. • Nutritional supplements sometimes cause stomach discomfort. Niacin-containing supplements may cause skin flushing and itching. • Rarely, individuals may experience allergic reactions to certain supplements and herbs. Please advise Sonya immediately if you think that you have experienced an allergic reaction. • Please let Sonya know immediately should you experience any negative side-effects from any of your homeopathic and wellness care. Important points to note: • Sonya McLeod does not guarantee treatment results. • A record will be kept of the health services provided to you. This record will be kept confidential and will not be released to others without your consent, unless required by law. You are entitled to a copy of your records at any time and to transfer of your records to another practitioner if desired. • Sonya will explain to you the exact nature of any treatment provided and will answer any questions you may have to the best of her ability. • You are free to withdraw your consent and to discontinue care at any time.