Homeopathic Consent Form

Casey Hammond has been studying homeopathy since 1995.  She has attended numerous seminars and classes as well as having completed a two-year certificate course with the New England School of Homeopathy (NESH) and two years of additional NESH training with clinical emphasis.  She has also studied with the Victorian College of Classical Homeopathy.  She is a registered nurse and is certified in Emotional Freedom Technique, Tapping Into Wealth™ and as a Truly Heal™ health coach.

Homeopathy by philosophy, science and practice does not diagnose or treat disease.  The diagnosis and treatment of disease is solely within the license of a more qualified medical professional.  If you know or suspect that you have a condition which may warrant the care of a more qualified medical professional, you should see one as soon as possible. 

Homeopathy treats underlying weaknesses and susceptibilities to the disease process by assessing through an interview the state of one’s mental, emotional and physical wellbeing.  Homeopathy is compatible with most orthodox, complementary or alternative medical treatments, so you may, depending on the circumstances, choose to utilize the benefits of more than one discipline.

I understand that all information disclosed is confidential and may not be revealed to anyone without my written permission, except if I am a danger to myself or others, or as disclosed by law.

I authorize discussion of my case notes and videos with other professional and student homeopaths should assistance in remedy selection and/or symptom analysis be required for myself (or my child) or my best interest be served by such consultation.  In doing so, my right to privacy will be protected by withholding my name and other identifying information.

I am 18 years of age or older and have voluntarily chosen homeopathic treatment for my self (or for my child).  I understand Casey Hammond is a student of homeopathy (not a certified homeopath) and not a medical doctor, and it is therefore recommended that I retain the services of a primary care physician for appropriate evaluations and check-ups for myself/child.  I further understand that Casey Hammond does not diagnose, treat, or prescribe for any particular symptom, disease or condition.  I understand that she will work on increasing my/my child’s general vitality and constitutional strength.




Name (Please print) ____________________________________

Address __________________________________________________

Phone # __________________________                             

Email _________________________________