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. If we do not receive complete paperwork, we will not call you. It is your responsibility to be certain that paperwork is complete when sent to us, or to call our office to follow up if you do not hear from us.
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 complete, 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 77063. Please send to the attention of “new client intake”
General Client Forms: (all forms are pdfs)
- General Client Checklist
- Sample timeline
- Fees
- General Client Disclosure and Consent for Services Form
- General Client Contact Information form
- General Client Health Questionnaire
- Credit Card Form
NON-USA clients must read, fill out and sign and include this form with your intake paperwork:
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 all required 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.
Please note: It is your responsibility to be certain that all paperwork, signatures, etc., are complete before mailing the intake information to our office. The checklist includes all required items for setting an appointment. We will not call you if we receive incomplete paperwork. If you have not heard from us, please call the office to be sure we have received it, or to find out what might have been missing.
Autism Spectrum Disorder Client Forms: (all forms are pdfs)
- ASD client checklist
- Fee Estimate
- Client Contact Information
- Disclosure and Consent for Services
- ASD health questionnaire
- ASD ATEC form
- Sample Timeline
- Credit Card form
NON-USA clients must read, fill out and sign and include this form with your intake paperwork:
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 frequently asked questions. Files in PDF formats will require Adobe Acrobat® to read. Files in .doc format will require Microsoft Word® to read.
ASD Frequently Asked Questions (pdf)>
ASD Frequently Asked Questions (.doc)>
In you do not have adobe acrobat you can download it here free.
