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Portland Clinic of Holistic Health Naturopathic and Chinese Medicine 833 SW 11th Ave, Suite 525, Portland, OR 97205 Phone: (503) 2947070, Fax: (971) 2008962CONFIDENTIAL NEW PATIENT INFORMATION Name:Date:Age:Date
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Start by reading through the holistic health agreement form to understand all the terms and conditions.
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Fill in your personal information such as name, contact details, and date of birth.
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Provide details about your medical history, including any ongoing health conditions or medications you are currently taking.
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Anyone seeking holistic health services or treatments should fill out a holistic health agreement.
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This agreement ensures that both the client and the holistic health practitioner are on the same page regarding the services being provided, expectations, and responsibilities.
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A holistic health agreement is a document that outlines the principles and practices of holistic health, which considers the complete individual—body, mind, spirit, and emotions—in the pursuit of optimal health and wellness.
Individuals or organizations that practice holistic health services or offer holistic health programs may be required to file a holistic health agreement, depending on local regulations and licensing requirements.
To fill out a holistic health agreement, one should provide accurate information regarding the services offered, practitioner qualifications, client consent, and any applicable terms and conditions. It is essential to ensure clarity and completeness.
The purpose of a holistic health agreement is to establish a clear understanding between the practitioner and client regarding the nature of the holistic services offered, ensuring informed consent and outlining responsibilities.
The information that must be reported includes practitioner details, service descriptions, client consent, treatment plans, fees, and any disclaimers or policies relevant to the practice.
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