You can completely these digitally but manual signatures are required for HIPAA Notification and Consultation Agreements at this time, do NOT submit these forms by Email:


Adult Registration Form (*.pdf): Please download, print, complete and bring this form to your first homeopathic consultation.

Child Registration Form (*.pdf): Please download, print, complete and bring this form to your child's first homeopathic consultation.

HIPAA Notification Form (*.pdf): At your first homeopathic consultation, you will be asked to read this form and verify by your signature that you have read it.


Consultation Agreement Form (Adult) (*.pdf): At your first homeopathic consultation, you will be asked to read this form and verify by your signature that you have read and understood it. This form is signed by me as well.

Consultation Agreement Form (Minor) (*.pdf): At your child's first homeopathic consultation, you will be asked to read this form and verify by your signature that you have read and understood it. This form is signed by me as well.


Symptom Tracking Chart
(*.pdf): You may be provided this in hard-copy form at the end of your first homeopathic consultation. If not, please feel free to download and print this one.


Off-site clients: Please visit https://www.wellnesscareonline.com .



Forms

Call (928) 247-6385 for a free 15-minute consultation

Anna Vakil PhD CCH

Board-certified in homeopathy

Certified metabolic balanceĀ® coach

Serving the southwest Arizona region