New Consultation Agreement 2026 · Appointments Only
↓ Please read the entire agreement carefully before signing ↓
Please fill out your questionnaire and email/mail it to me 3–5 days before your appointment.
At this time, all consultation appointments will be held with the use of the Zoom Healthcare Platform. Appointments must be canceled or rescheduled at least 2 days prior to the agreed upon time. You will be sent text and e-mail reminders of your appointment. Please confirm your attendance. Please be on time. If you are late the visit will be shortened or may have to be rescheduled. The fee for your appointment is unchanged.
All consultations are arranged by appointment only. It is my practice to not communicate by text. Please send brief alerts only. In cases of a medical emergency please call 911 or go to your nearest hospital emergency facility, urgent care, or Primary Care Provider.
I understand that my practitioner is not a medical doctor, has not presented herself as such, and does not seek to diagnose, treat, or prescribe for disease, disorder, or other pathological conditions. Homeopathic care does not replace the need for preventative health care.
My office does not file insurance claims or pursue payment from insurance companies. Payments are made directly to me at the time of consultation.
HIPAA provides you with several rights regarding your client records including requesting amendments, restrictions on disclosures, accounting of disclosures, and the right to a copy of this Agreement and privacy policies.
The laws and standards of my profession require that I keep protected Health Information about you. You may examine and/or receive a copy of your record if you request it in writing.
Clients under 18 years of age who are not emancipated — parents should be aware that the law may allow parents to examine their child's treatment record.
Concerns should be mailed to: Councils of Homeopathic Certification, P.O. Box 73, Lewisville, AR 71845.
At this time, fees will be paid cash, check, or Venmo @ suzanne-arkoosh-1. You will be expected to pay for each session at the time it is held. A $25 late fee will be incurred after 30 days. After the consultation has been paid in full, the homeopathic remedy will be mailed from my office or directly from one of the homeopathic pharmacies.
If your account has not been paid for more than 60 days and arrangements have not been agreed upon, I have the option of using legal means to secure payment.
Practitioner agrees to honor confidentiality and assures professional conduct as defined by the Code of Ethics of the Council of Homeopathic Certification. Client agrees to consult a licensed physician for any medical concern that now exists or arises during the term of this agreement.
Please initial each section below to confirm you have read and understand the terms:
I give Suzanne Arkoosh permission to evaluate and treat the above-named client's health problems. I understand that Mrs. Arkoosh uses Homeopathy, Cell Salts, and Gemmotherapy exclusively, and that treatment is therefore different from what would be prescribed by the majority of health care providers. I understand that I need to pursue diagnostic testing or cancer screening through another health care provider. I understand that at all times I reserve the right to terminate homeopathic treatment in favor of standard medical care.