Homeopathy Client Forms
General Client intake forms
Welcome! If you are interested in setting up an appointment with one of our practitioners, below are two sets of forms. While our focus is on persons with autism spectrum disorders, we have a general practice for chronic and acute illnesses, health and wellbeing. Please click the appropriate forms below if you are interested in working with us on illnesses outside of autism spectrum disorders. You must fill them out completely and return them to our office. We have included a checklist for each set of forms so that you will be sure to provide us with all the necessary information before we can set up an appointment. If your paperwork is not complete, we will be unable to set an appointment until we have everything in our office.
For General clients please print all of the forms below, sign them, and return original signed copies to our office by postal mail (No faxes or emails please – we must have accurate information to adequately evaluate and advise on your health situation, and faxes tend to mangle information!).
Our address is: Homeopathy Center of Houston, 7670 Woodway Drive, Suite 340, Houston, TX 77043. Please send to the attention of “new client intake”
General Client Forms: (all forms are pdfs)
- General Client Checklist
- Sample timeline
- General Client Business forms
- General Client Questionnaire
- Credit Card Form
Autism Spectrum Disorder intake forms
If you have a child who has been diagnosed with autism or an autism spectrum disorder, please print the following set of forms, fill them out completely, sign them and return the original signed copies to our office by postal mail (NO FAXES PLEASE!), along with the additional information requested in the checklist. We cannot be responsible for the return of photographs sent to us, so please make copies for us, and retain any irreplaceable photos, records, etc.
Appointments cannot be set if we do not have original signatures on all documents. Also, for a child who is under 18 years old, or a person over 18 who is unable to make these decisions for him/herself, we must have the signatures of both parents or legal guardians before we set the appointment.
Autism Spectrum Disorder Client Forms: (all forms are pdfs)
- ASD client checklist
- ASD Client Business forms
- ASD health questionnaire
- ASD ATEC form
- Sample Timeline
- Credit Card form
Thank you for your interest. Please allow at least 1 week for mailing time within the USA, and 2 weeks for international mailing for us to receive and process your forms. We will call you if there is any missing information, and once that is received, we will offer you an initial appointment with one of our homeopaths, on a space-available basis.
We look forward to serving you!
Sincerely,
Cindy Griffin, Lindyl Lanham, Julie Adams, Jenice Stebel
And the Staff of Homeopathy Center of Houston
Homeopathy & Autism Frequently Asked Questions
Below are links to information on frequesntly asked quesistions.All Files are PDF formats. You will need adobe acrobat in order to view these forms
ASD Frequently Asked Questions >
International Clients
If you reside outside the United States, it is usually possible for us to
work with your child (autism spectrum only), but there are added costs, and
procedures. All international clients (non-USA) must additionally read and
sign this disclosure form and agreement. Thank you."
In you do not have adobe acrobat you can download it here free.
