Consent Form
INFORMED CONSENT FOR HOMEOPATHIC CONSULTATION AND TREATMENT
Purpose of Consultation: I, the undersigned, now consent to a homeopathic consultation with Dr. Ahmed Masood at Blossom Homeopathy to explore natural remedies and seek complementary health solutions for my well-being or that of my child, if applicable.
Practitioner Background: Ahmed Masood is a professional homeopath trained as a Classical Homeopath, recognized as an Advanced Practitioner of Homeopathy (A.P.H.), and not a Nevada licensed medical doctor. His holistic approach focuses on emotional, mental, and spiritual states rather than disease names. He prescribes remedies based on a non-stimulant lifestyle for effectiveness.
Scope of Practice: Homeopathy is a holistic healing method, not a substitute for conventional medical Treatment. It supports the body's healing abilities with remedies derived from natural sources. I understand that Ahmed Masood does not diagnose, treat, or prescribe for specific symptoms, diseases, or conditions, nor will he advise discontinuation of allopathic drugs without consultation with the prescribing medical practitioner.
Confidentiality: I will only disclose any information shared during the consultation with my written permission or where legally required.
Consent to Treatment: I voluntarily agree to receive homeopathic consultation and any prescribed remedies. I can ask questions and will be informed about the benefits and potential side effects.
Emergency Situations: I will seek immediate medical attention in emergencies or if I experience unexpected reactions to remedies and inform Dr. Masood as soon as possible.
Financial Agreement: I agree to the consultation fees and understand the charges for any remedies or follow-up appointments. I commit to timely payment for services rendered.
Cancellation and Refund Policy: I have been informed of and agree to Blossom Homeopathy's cancellation and refund policies.
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Parental Consent (if applicable): As the parent/guardian, I consent to the consultation and Treatment for my minor child and have been informed about homeopathy.
Right to Withdraw Consent: I may withdraw my Consent without affecting future care or Treatment.
Acknowledgment: I have been sufficiently informed about homeopathy, its benefits, and its risks, making my participation entirely voluntary. Homeopathy's efficacy and safety record is notable compared to conventional medicine, making it my chosen option for seeking a holistic approach to health.
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Supervisory and Regulatory Compliance: I understand that Ahmed Masood's practice is under the direct supervision of Dr. Robert Eslinger, DO, HMD, ensuring adherence to the highest standards of homeopathic care. This arrangement complies with the Nevada State Board of Homeopathic Medical Examiners, as mandated under Chapter 630A of the Nevada Revised Statutes. The protocols governing the Advanced Practitioner of Homeopathy (A.P.H.)—including those related to the non-discontinuation of allopathic drugs—are available for inspection and are practiced under the guidance and oversight of Dr. Eslinger to ensure safety and efficacy.