Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Are you the one needing care? Adult or parent of a minor must sign consent form *

If you are not the one receiving care, please fill out the client's name, date of birth, and gender below.

Yes

No

Client Name

First Name

Last Name

Client Date of Birth

MM

DD

YYYY

Gender

Male

Female

Date the Symptoms Began *

MM

DD

YYYY

Is the client currently working with a homeopathy? *

Yes

No

Has the client ever used homeopathy? *

Yes

No

Preferred Method of Contact *

Online Video (Zoom)

Phone Call

Nature of Acute Situations *

Acute conditions typically have a recent, rapid onset and differ from ongoing health conditions. Examples include: a recent injury or a stomach bug. Chronic conditions typically develop slowly and are long-standing issues like asthma, hormonal concerns, frequent headaches, or diabetes. If you’ve been sick or dealing with viral symptoms over the past few months and are still struggling to get well, I can still help, however a chronic consult may be required. It is up to Sarah Karasch to determine if acute or chronic care is appropriate.  Please mark a checkbox blow that you have read and understand the above statements.

I agree

I do not agree

Fees *

Acute Consultations for non-existing clients are $65 and includes up to 3 days of care. If you are a current chronic client (you have had a follow up within the past 2 months), there is no charge for simple acute care. Complex acutes requiring more than one remedy and more time intensive care may be billed at a reduced rate of $40. Payment is required at the time of booking and will be required before a remedy recommendation is given out. If you initially have an acute situation that does not resolve in a timely manner, you will be referred to extended acute and be charged $30. This matter will be discussed if it should arise. Extended acute situations can be things like: Lingering coughs for more than 10 days Worsening of acute conditions Stubborn sinus infections Allergic reactions eg, hives Side effects of conventional treatments Post surgical issues and support Head injuries (concussions) Pregnancy related issues like morning sickness Postpartum support Sarah reserves the right to refer to Chronic Care if your health concerns have not improved in a timely manner or whenever she recommends that your health would benefit better from chronic homeopathic care.   Additional fees ($20) apply for weekends/holidays if Sarah is available.  Please mark a checkbox indicating that you agree to the fees listed above.

I agree

I do not agree