Informed Consent/ Full Disclosure Agreement
Statement of Philosophy
People seek service from an herbalist for help with an imbalance or as a way to strengthen their constitution. In my clinical practice I approach people and plants with the idea of embodying wholeness. After taking a detailed history I will utilize my knowledge of constitutional theory, body systems, phytochemistry, and client input to determine which herbs will support the body best. Herbalists believe in treating the person not the disease, therefore I am not only interested in your physical well-being but also in your mental well-being.
In a session, clients may fill out a detailed questionnaire. I will ask questions about your past and present experiences. I may measure blood pressure, look at your tongue, feel the pulse, or ask to see the afflicted area. The session is mostly conversational. After our session I will spend additional time formulating and creating a suggested protocol. I typically spend 2-3 hours researching medication interactions, pathology, and/or making herbal blends. Clients will receive an email within 1-3 days that outlines these suggestions that include lifestyle changes, nutritional support, and recommended herbs. I may formulate an herbal product to address the imbalance. The formula is usually in tincture form but I may also give teas, salves, sprays and/or ointments. I may suggest capsules, teas, or other herbal products available from trusted sources that the client can order themselves online or pick up at a local store.
Herbalism is not licensed by the state of California or anywhere in the USA. I am certified through the Berkeley Herbal Center located in North Berkeley. I completed the 3 year course and an internship in the community clinic there in 2013. My services are complementary in nature. I am not a medical doctor. Legally, I cannot diagnose or recommend the discontinuance of drugs or controlled substances prescribed by a licensed physician.
Fees and Policies
Initial Intake/Herbal Wellness Consultation- The initial consultation takes 1.5 hours. The current intake fee is $250 and includes a 20 minute follow up session to ensure progress. This first follow up is our chance to address any dosage or issues with herbs and methods used so changes can made if needed and provide a confident and informed initial approach. Additional follow ups are usually suggested every 1-3 months, depending on needs.
Follow Up Intake - These appointments can last 30 minutes to 45 minutes. The fee is $100. These appointments are important to make changes to any herbal protocol as needed, provide support, discuss improvements or new symptoms, and track progress.
Acute Illness- These appointments can last up to 1 hour. The fee is $150. This type of session is designed for support for things like sinus infection, colds and flu, stomach bugs, injuries, and any sudden shift in wellness that has a clear point of origin that could benefit from a holistic approach to promote healing.
Pet Wellness Consultation- These appointments can last up to 1 hour. The fee is $150. This session is for dogs and cats only at this time.
Refills- Reformulating or refilling an herbal product without an appointment cost is $15 for up to two items. Additional charges may apply. Refills are only available to clients who have been evaluated by me within a six month period.
Cost of Herbs- $15 per fluid ounce for extracts. Teas and whole herbs are sold for $6 an ounce. Salves, ointments and sprays are generally $10-$20 per item. All herbs are organic or ethically wild crafted and provided at wholesale prices. All herbal products are made by Sarah Jane Fairless and formulated to fit your unique needs. I am devoted to creating high quality products with environmental awareness and potency. Shipping costs for herbs is not included in this price.
Shipping Costs- If herbs are shipped they will be sent via Priority Mail USPS. Cost is current market rate and payment is required before items are shipped. A tracking number will be provided.
Cancellation- Please give at least 24 hours notice if you need to cancel an appointment. Failure to do so could result in a 25% fee for services requested. Failure to give 24 hour notice on 3 separate occasions will result in a discontinuation of services offered.
Payment- Venmo (preferred), Paypal, and credit cards are accepted. There is a 3.5% processing fee for credit cards, please add this to your square payment amount if choosing this method. Payment is required to secure your preferred consultation time.
Formula changes- Changes to a formula require an appointment.
Issues with herbs given- Please email me with any concerns and I will respond as soon as possible! Your experience and health are my top priority!
Herb Safety
Herbs should not be used in pregnancy or lactation without expert advice. If you become pregnant you should stop taking herbs until advice is received either from your herbalist or another knowledgeable professional.
It is your responsibility to fully disclose any medications currently in use, including other herbs and supplements so that you can be offered informed advice. It is recommended that you inform your doctor of all herbal and nutritional supplements that you are taking. Any suggestion that the effect of a drug is being altered by simultaneous use of an herb should be reported directly to all health professionals involved.
It is your responsibility to report any negative or unpleasant symptoms that emerge as a result of taking any herbs. If such things do occur, please stop taking the herb(s) immediately and promptly contact me or your primary care physician. Rare allergic reactions to even the most mild of herbs can happen.
It is advisable to stop taking herbs at least 48 hours before a surgical operation and in the event of being given or prescribed anticoagulants, anti-epileptic drugs, and digoxin. In general, consult your doctor and herbalist when being prescribed or changing medication.
Reimbursement Structure
Consultation fees are non refundable. Refunds and/or exchanges of herbal formulas are done on a case by case basis.
Client Redress
If for any reason the services provided do not meet with the expectations as outlined in this consent form, please call or email Sarah Jane Fairless. I will make every attempt to resolve the conflict.
Release of Liability
I, the undersigned assume all responsibility for the decisions I make concerning my health care, recognizing that (a) no claims are made about herbal medicine to treat or cure any medical condition, (b) all information given is for educational purposes only, (c) there is no implied or guarantee of success or effectiveness of any specific plan or treatment, (d) I am free to act on or disregard the recommendations of Mrs. Fairless as I so choose. I hereby release Sarah Jane Fairless from responsibility of my actions and consequences thereof in present time and in the future with no constraints. I hereby affirm and consent to the above statements with my own free will, and request to engage in the services provided.