Retainer Agreement for Homeopathic Practice

[swiftsign swift_form_id=”SWIFTFORMIDHERE”] I, [swift_name size=”medium”], hereby retains Ron Frank, D.H.M. as a homeopathic practitioner.

I understand that Ron and associates do not seek to diagnose, treat, or prescribe for illness, injury, disease, disorder or other pathological conditions. Instead, he seeks to stimulate my own defense system with the use of homeopathic remedies and adjunct therapies, so that I can better deal with the wide variety of stresses I experience. In exploring this homeopathic practice, I am interested in monitoring my confrontation with stress and in stimulating my own healing abilities to move through crisis naturally.

I have had ample opportunity to discuss the relationship between the treatment of pathology and the employment of this homeopathic approach as practiced by Ron Frank, D.H.M. and his assistants. I agree to consult a physician for any concern about pathology which may arise during the term of this agreement, and to inform Ron Frank, D.H.M. of such consultation and its results.

In choosing this approach, I realize that some of my symptoms of discomfort may get worse before they get better, and I could elect to minimize or eliminate uncomfortable symptoms by obtaining treatment, according to accepted standards of medical practice, from a physician. I am responsible for my health and any contraindicated medications, remedies, or lifestyle changes I will make myself aware of from an accepted standard medical physician.

In order to maximize the benefit which I might receive from this work, I agree to:

1. Provide a complete summary of medical and non-medical health care services which I have sought or am considering.
2. Avoid coffee and camphorated products which may neutralize homeopathic remedies.
3. Keep a written summary of mental, emotional and physical manifestations, noting any subtle changes observed.
4. Directly inform Ron Frank, D.H.M. of the results from the homeopathic remedy within 4 weeks from the last visit.
5. Notify Ron Frank, D.H.M. of my desire to terminate this agreement within 90 days of my last visit. ( Ron continues to work for clients even between visits on his own time)
6. If I feel or suspect any negative symptoms are being produced from any recommendations from this work, I will immediately stop those recommendations and inform Ron Frank, D.H.M. (This is a gentle process. Please do not push for results.)


Practitioner, Ron Frank, D.H.M. agrees to elicit a history of indications relevant to the client’s constitutional disposition, advise the client accordingly, and provide the client with an opportunity to undertake homeopathic remedies, or adjunct therapy remedies, according to the principles of the empirical science of homeopathy and those adjunct therapies.This agreement shall remain in effect, unless terminated by notice from either party to the other.

Client agrees to compensate Ron Frank, D.H.M. for his time with a payment of $200 for the initial visit, and $80 for any follow-up consultations. Short telephone consultations lasting no more than 15 minutes for established clients, are $40. It is understood that the same fees apply for office, phone, Zoom, or Skype consultations.

By signing this on-line agreement you understand Ronald Frank, D.H.M., D.I.Hom., CNHP, is also formally signing this agreement with you and the date stamp will be applicable to both of us.

If you fully understand and agree, please sign.

[swiftsignature] Signed and agreed on this [swift_date_long].
Addendum A:
[swift_initials] I also warrant I am accurately representing myself and my full intentions to improve my health and none other.
Primary Email: [swift_email name=”email” required] [swift_button] [swiftsign swift_form_id=”1966″] [/swiftsign]